title: Measurement of globe position in complex orbital fractures. II. Patient evaluation utilizing a modified exophthalmometer.
abstract: Globe position was assessed by both the Hertel exophthalmometer and the modified external auditory canal (EAC)-fixated device in 27 patients with complex orbital fractures (18 tripod and 9 Le Fort fractures). Although 94% of the patients with tripod fractures had relative exophthalmos on the fracture side or no difference between eyes by Hertel exophthalmometry, greater than 30% of the same patients showed relative enophthalmos when measured by the EAC-fixated device. In three of four patients undergoing surgical repair of the orbital floor, modified exophthalmometry showed exophthalmos of greater than or equal to 2 mm postoperatively on the fractured side. The relatively low incidence of enophthalmos in tripod fractures indicates a need for selective orbital floor repair; the uniform exploration of the orbital floor should be discouraged. Multiple comminuted facial fractures (Le Fort II and III) showed a greater variability in globe position and a high frequency (90%) of enophthalmos, suggesting a need for early orbital repair in these patients. EAC-fixated exophthalmometry can provide meaningful information regarding globe position in orbitofacial fracture patients in which orbital rim-based methods are precluded.
authors.affiliation: Wake Forest University Eye Center, Bowman Gray School of Medicine, Winston-Salem, North Carolina.
authors.forename: R P
authors.initials: RP
authors.lastname: Yeatts
mesh_terms: D000328:Adult; D004424:Ear Canal; D015841:Enophthalmos / Q000473:pathology* / Q000601:surgery; D005094:Exophthalmos / Q000175:diagnosis / Q000601:surgery; D005123:Eye / Q000473:pathology*; D005147:Facial Bones / Q000293:injuries / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000295:instrumentation; D009917:Orbital Fractures / Q000473:pathology* / Q000601:surgery; D012887:Skull Fractures / Q000175:diagnosis / Q000601:surgery