A 34-year-old man without any underlying disease was transferred to our hospital for swelling of the left periorbital area after being hit by a baseball. An orbital computed tomography (CT) scan showed an orbital floor fracture (). Reconstruction of the depressed orbital floor with porous polyethylene implant (Medpor; Porex Corp., College Park, GA, USA) and insertion of a negative pressure drainage tube were performed. Before surgery, ophthalmologists confirmed the absence of abnormalities on the left eye. No complications were observed until the third postoperative day. On the 4th postoperative day, the patient went outside and smoked a cigarette. It was winter at the time, and the temperature was –3°C. A few hours later, the patient suddenly presented with severe eye pain, edema, and chemosis. Relevant medical information including vital signs and smoking history are presented in . The patient’s blood pressure and pulse rate were slightly increased after the onset of these symptoms. Unilateral proptosis and a dilated pupil were observed and the patient’s visual acuity on his left eye decreased from 20/20 initially to hand motion. A diagnostic enhanced facial CT scan revealed a 22× 16× 12 mm retrobulbar hematoma and 25 mm of exophthalmos (-). Since the signs of retrobulbar hematoma were unequivocal, a decompression procedure was immediately performed without measuring the intraocular pressure. Bedside decompression via suture removal was performed immediately. Medical treatment including intravenous steroids and 20% mannitol were administered simultaneously. Approximately 2 hours after the onset of initial symptoms, emergency exploration under general anesthesia was conducted (). Intraoperatively, 3 mL of hematoma as a form of fluid collection was evacuated from the inferior portion of the orbital cavity near the previously inserted Medpor. The quantity of hematoma was also measured as 3.025 mL using the picture archiving and communication system software, Dejaview (Dongeun IT, Bucheon, Korea). Active arterial bleeding was not seen, but diffuse oozing was observed. Meticulous hemostasis was performed after removal of the Medpor. A negative pressure drainage tube was inserted, and the wound was closed. No abnormal findings were observed during the postoperative ophthalmic examination. Subsequently, visual acuity on his left eye was restored to 20/20. On the 4th postoperative day, the drainage tube was removed. On the seventh day, the patient was discharged. No complications were observed in subsequent follow-up examinations at 1, 2, and 4 weeks, and protrusion of the left eye also resolved ( and ).
A 57-year-old male was injured in the face when falling down while working on a 3-m-high roof and immediately visited our emergency room. The patient exhibited limited ocular movement and diplopia when gazing upward, downward, and in both lateral directions, and he was examined and diagnosed with left orbital floor and medial wall fracture (Fig. ). He was admitted to the Oral and Maxillofacial Surgery for orbital wall repair. The patient’s visual acuity evaluated by preoperative ophthalmology was measured at Rt. 1.2/Lt. 1.5. Orbital wall reconstruction was performed 5 days after injury. On day 1, there was no pain and mild chemosis, his eye movements returned to normal, and mild diplopia remained when gazing downward. Postoperative CT revealed retrobulbar hematoma (Fig. ); corticosteroids were administered, and the patient’s course was monitored. At 2 days after surgery, the diplopia interval became narrower, and after 1 week, normal visual acuity was measured at 1.2/1.5. After 2 months, the diplopia was fully recovered, and the patient’s visual acuity was normal.