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 21-year-old male was assaulted in the face, visited a hospital in another area and was diagnosed with orbital and nasal bone fractures (Fig. ). After diagnosis, he visited the Oral and Maxillofacial Surgery of Kangwon-University Hospital the next day and was hospitalized for surgery. The patient had limited ocular movements and diplopia with upward and downward gaze, along with facial sensory impairment and nasal deformity. His visual acuity evaluated by preoperative ophthalmology was Rt. 0.3/Lt. 0.3. Two days after the injury, orbital wall reconstruction and nasal bone repair were performed under general anesthesia. On the 1st day, there was slight swelling, chemosis, and mild pain at the surgical site. The diplopia was almost improved, and there were no significant problems with his vision. The damaged skin sensation had also improved significantly. Therefore, corticosteroids were administered, and the patient’s course was monitored (dexamethasone 15 mg/day). On the second day of surgery, the patient complained of severe ocular pain and exhibited severe ocular protrusion. His vision also began to deteriorate rapidly, and ophthalmology asked for an evaluation. The CT showed retrobulbar hematoma (Fig. ). The patient’s right eye visual acuity decreased to 0.01, and the intraocular pressure was elevated. Lateral canthotomy and cantholysis were immediately performed to reduce the intraocular pressure, and the hematoma was removed under general anesthesia. The next day, the patient’s pain was significantly decreased, and chemosis was decreased, but diplopia was observed when the patient gazed downward. The visual acuity was 0.04. After that, the pain was almost improved. After 1 week, the patient’s visual acuity improved to 0.2, and the corrected visual acuity was 0.7. Three weeks after surgery, his visual acuity was improved to 0.3. At 7 weeks after surgery, both eyes were corrected to 1.2, and the diplopia was improved. At 6 months after surgery, his visual acuity was normal, and the scar was not noticeable; however, mild diplopia when gazing downward was still present (Fig. ).