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. ).
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.