A healthy 24-year-old man fell and struck his left eye prior to admission. His visual acuity and intra-ocular pressure were normal. The CT scan revealed approximately 25 mm×21 mm and 18 mm×15 mm fractures, and pneumo-orbits of the left orbit medial wall and floor, respectively (). There was also a 2 mm enophthalmos on his left eye. Orbit wall reconstruction was performed using porous polyethylene (Medpor, Howmedica Osteonics, Newnan, USA) on the eighth day after the injury. The visual acuity and light reflex in both eyes were normal after the surgery. About 29 hours after the orbit wall reconstruction, the patient suddenly complained of blurred vision, mild pain, bulbar pressure, and circumbulbar hardness without any precipitating factors. Due to the observation of ecchymosis in the medial canthal area and of subconjunctival hemorrhage, retrobulbar hematoma, and significant proptosis in a CT scan (), emergency surgery was performed within one hour of the manifestation of the symptoms. An active bleeding point was not observed during the exploration. However, decompression was performed through hematoma drainage after the region of the suspected microbleeding was gently cauterized with hemostatic forceps. A scalp vein set tube was located and fixed in the reduced fracture region. A suction drain was connected and continuously drained during the surgery. Afterwards, a negative-pressure syringe was connected to enable drainage. The pain was immediately reduced and the vision improved after the surgery, and the eyeball movement, visual acuity, and intra-ocular pressure remained normal during the follow-up period.
A healthy 20-year-old man complained of discomfort in his left eye caused by assault. His visual acuity and intra-ocular pressure were normal. The physical examination showed no signs of diplopia or gaze limitation. However, since there were computed tomography (CT) findings of an approximately 21 mm×18 mm fracture, and trapping of the ocular content and the inferior rectus muscle accompanied by displacement of the left orbital floor (), orbital wall reconstruction was performed using a re-absorptive polymer mesh (Floor liner, Medtronic, Minneapolis, USA) seven days after the injury. It was performed without difficulty and there was little bleeding in the operation field. The light reflex in both eyes was normal after the surgery, and there were no specific ocular symptoms other than subconjunctival hemorrhage (). On the fifth day, the patient's visual acuity and intra-ocular pressure were restored to preoperative levels, so the patient was discharged without any specific symptoms. Ten days after the reconstruction, the patient visited our hospital complaining of loss of sight two to three days earlier. The patient considered the symptom temporary following surgery, and there were no accompanying symptoms such as pain. As for the visual acuity, the patient did not perceive light and was positive for relative afferent papillary defect. His intra-ocular pressure was normal, and there were no specific findings during the ophthalmic examination. A CT scan was immediately performed. Since retrobulbar hematoma up to the apex was observed (), the authors immediately removed and decompressed the hematoma and started systemic steroid therapy (250 mg per 6 hours of methylprednisolone for three days, and steroid tapering). However, there was no visual recovery.