Adult Orbital Fractures with Extraocular Muscle Entrapment

Abstract

Orbital fractures with entrapment are well described in children but occur less frequently in adults. The true incidence, natural history, and ideal timing of surgical intervention of adult orbital fractures with entrapment are unknown. A single institution, retrospective chart review of 5 adult patients with orbital fractures with entrapment who underwent surgical intervention and had at least 1 follow up visit was performed. Ages ranged from 21 to 62 years old (mean = 37.6). Timing between initial presentation and surgery ranged from 14 to 62 hours (mean = 34.8). Intra-operatively, all patients had clinical entrapment of extraocular muscles and underwent surgical release followed by orbital implant reconstruction. Follow up ranged from 1 week to 1 year (mean = 16 weeks). Three of 5 patients had significant improvement of extraocular movements at their last follow up. Two patients had residual exotropia and difficulty with adduction; one was a unique case with medial rectus transection which has not been previously described. It is important that clinical suspicion for entrapment remains high in orbital fractures even in adult populations. Based on current literature, early surgical intervention is recommended for adult patients with entrapment even in the absence of oculocardiac reflex.