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.
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.