title: The transcaruncular approach to orbital fracture repair: ophthalmic sequelae.
abstract: The transcaruncular approach to the medial orbit is growing in popularity and although reported complications are minimal, ophthalmic and orthoptic sequelae can occur after any conjunctival surgery and nonophthalmic surgeons should be aware of these. This study aims to document these sequelae in a cohort of patients having transcaruncular surgery. A retrospective case series of all consecutive patients undergoing orbital fracture repair through a transcaruncular approach for medial wall and floor fractures in two centers over a 2-year period was examined. Computed tomography findings, pre- and postoperative ophthalmic and orthoptic findings, including ocular motility (with Hess chart evaluation), Hertel exophthalmometry, slit lamp biomicroscopy examination, follow-up time, and occurrence of complications were recorded. Thirteen patients, mean age 34 years (range, 18-82 years), underwent repair for medial wall (n=5) or combined medial wall and orbital floor (n=8) fractures with median a follow up of 7 months (range, 2-18 months). Preoperative ocular injuries included conjunctival chemosis, eyelid swelling, subconjunctival hemorrhage, retinal haemorrhage, traumatic uveitis and traumatic mydriasis, eye movement restriction, and enophthalmos (range, 3-4 mm). Postoperatively, corneal epitheliopathy with reduced vision (6/60), orbital inflammation, inferior oblique underaction, and superomedial fornix symblepharon at the caruncular incision sight each occurred in one patient along with extensive subconjunctival hemorrhage and a suture-related conjunctival granuloma in others. All patients experienced an improvement in diplopia and globe restriction. Ophthalmic complications can occur with this approach, and so it may be advisable to seek an ophthalmic opinion with the aim of comanagement in planning this approach.
authors.affiliation: Corneo-Plastic Unit, Queen Victoria Hospital, West Sussex, United Kingdom, and the Department of Ophthalmology and Visual Sciences, University of Adelaide, South Australia, Australia. malhotraraman@hotmail.com
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
authors.forename: George M
authors.initials: GM
authors.lastname: Saleh
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: de Sousa
authors.forename: Ken
authors.initials: K
authors.lastname: Sneddon
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003229:Conjunctival Diseases / Q000209:etiology; D003231:Conjunctivitis / Q000209:etiology; D005130:Eye Hemorrhage / Q000209:etiology; D005141:Eyelid Diseases / Q000209:etiology; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D009917:Orbital Fractures / Q000601:surgery*; D012189:Retrospective Studies; D014786:Vision Disorders / Q000209:etiology