Missed orbital wall blow-out fracture as a cause of post-enucleation socket syndrome.
BACKGROUND
Post-enucleation socket syndrome (PESS: deep upper lid sulcus, ptosis or upper lid retraction, enophthalmos and lower lid laxity) is a well-recognised complication of a volume-deficient anophthalmic socket. A patient requiring enucleation following severe ocular trauma may have an underlying orbital wall blow-out fracture which if overlooked can cause severe volume deficit with poor cosmesis and limited prosthesis motility.


OBJECTIVE
To establish the prevalence of an undiagnosed blow-out fracture in patients with PESS and a history of relevant trauma.


METHODS
Medical records and orbital computed tomography (CT) scans were reviewed for all patients presenting with PESS and a history of relevant trauma.


RESULTS
Undiagnosed blow-out fractures were found in 15 (33%) of 45 patients presenting between August 1993 and December 1996. These were significant enough to warrant surgical repair in 13 (29%) patients.


CONCLUSIONS
We suggest that any patient presenting with PESS and a history of relevant trauma should be considered to have an orbital wall blow-out fracture until proven otherwise by CT scanning of the orbit. Similarly any patient requiring enucleation following severe ocular trauma should undergo CT scanning to rule out a coexisting blow-out fracture which could be repaired at the time of enucleation.
Ataullah
S
S
Manchester Royal Eye Hospital, UK.
Whitehouse
R W
RW
Stelmach
M
M
Shah
S
S
Leatherbarrow
B
B
D000328:Adult; D003951:Diagnostic Errors; D015841:Enophthalmos / Q000209:etiology*; D015353:Eye Enucleation; D005141:Eyelid Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013577:Syndrome