A Rare Case of Postoperative Traumatic Optic Neuropathy in Orbital Floor Fracture

Fig. 1. (A) Patient with posttraumatic enophthalmos and hypoglobus of the right eye. (B) Upward gaze limitation was noted on preoperative day 1. A B or a nerve sheath injury whereas direct damage to the optic nerve during dissection and insertion of implant materials is also possible. We report a case of a patient with postoperative traumatic optic neuropathy due to indirect nerve damage after traction force might be applied to release a severe adhesion during a dissection procedure. A 35-year-old female patient was referred from the ophthalmology department complaining of enophthalmos on her right eye and presented for surgical correction of a right-sided upward gaze limitation. The problem was first found 2 years prior to visit after she was hit by a slamming door, but the patient did not receive immediate treatment at that time. A physical examination revealed right-sided enophthalmos (3 mm) and restricted mobility of the right eye during upward gaze without a visual defect (Fig. 1). The difference in anteroposterior position between the eyes was measured by Hertel exophthalmometry. Small amounts of enophthalmos (less than 3 mm) are not easily detectable and clinically insignificant but larger fractures of the orbital walls could result in severe enopthalmos (3 mm or greater) which is easily noticeable with blind eye [2]. Visual acuity was within the normal range on the right 0.9 and left sides 0.7. Computed tomography (CT) images showed a focal bony defect and herniated inferior rectus muscle and fat at the medial aspect of the inferior wall of the right orbit (Fig. 2). The orbital periosteum was incised on the inferior orbital rim sharply through a subcilliary incision under general anesthesia. Thickened fibrotic tissue A Rare Case of Postoperative Traumatic Optic Neuropathy in Orbital Floor Fracture