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 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.