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. ).
A 47-year-old male was involved in a traffic accident while driving in a car. Immediately after the accident, he visited our emergency room, and primary closure was performed. He was admitted to the Department of Oral & Maxillofacial Surgery for surgery of the orbital floor and medial wall fracture. His right eyelid had a wound of approximately 2 cm and was severely swollen so that his right eyeball was barely visible. Subconjunctival hemorrhage was present, and his vision was somewhat reduced. In the preoperative ophthalmologic examination, his visual acuity was 0.2 in the right eye and 1.0 in the left. There was a limitation of eye movement upward, and the patient experienced diplopia when looking forward and upward. Computed tomography revealed fracture of the right inferior and medial orbital wall and entrapment of the inferior rectus muscle with orbital fat herniation (Fig. ). Six days later, the surgery was performed, with reconstruction of the orbital wall. On the day of surgery, there was no specificity. However, at dawn on the day after surgery, the patient complained of severe pain and proptosis in the right eye and no vision. Retrobulbar hematoma was confirmed on CT, and the patient was consulted to ophthalmology. The intraocular pressure of the right eye did not appear to be high; thus, lateral cantholysis was not performed. The patient was followed-up with, and he was treated with systemic corticosteroids in a standard dosage for 3 days (dexamethasone disodium phosphate, 15 mg/day). However, his vision did not recover, and on the third postoperative day, the access was reopened, and hematoma removal was performed (Fig. ). One week later, his vision had not recovered, and ophthalmologic examination revealed blindness due to central retinal artery occlusion. The right fundus could be seen and showed a red spot, and white edema appeared to be caused by a complete CRAO. One month later, the optic disc appeared pale and atrophic (Fig. ).