Diplopia in Zygomatic – Complex Fracture

The purpose of this study was to investigate the incidence, etiology, treatment modalities, morbidity and types of diplopia in zygomatic complex fracture. Fifty patients with zygomatic-complex fractures who had attended the out-patient review clinic at Manchester Royal Infirmary in Manchester United Kingdom formed the study group. Information for the study was gathered from patient records from 10 Jan 2004 to 20 July 2004. Ethical approval was gained from the local research ethics committee. Fifty study group patients were examined clinically and radiographically. They also underwent orthoptic investigation. Out of these nine patients presented with diplopia as a result of their injury and following surgical exploration of the infraorbital floor. Eight patients had diplopia in the upward gaze and one patient experienced diplopia in the downward gaze. One patient had persistent diplopia at 12 weeks. In patients who presented with diplopia, assault was the most common aetiolog (66%). Statistically analysis revealed a significant difference between assault as the aetiology and the types of diplopia (p<0.02). Fifty-six percent of patients had surgical intervention for diplopia between 8 and 13 days post injury. In this patient group, the subcilliary incision was a common surgical approach for the orbital floor (40%). Diplopia was the presenting symptom in 6 patients with zygomatic-complex fractures involving the orbital floor and also in 4 patients with body complex fractures. Diplopia resolved within one week after surgery in two patients (22.2%) and within 3 weeks after surgical intervention for 6 patients (66.7%). However, one patient recovered after 12 weeks. This study highlights the importance of evaluating the symptoms of diplopia and its appropriate management. Indications for early operation are: symptomatic diplopia with positive forced duction and CT evidence of entrapment of orbital fat or septae with no improvement over 1 to 2 weeks.