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 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.