Resolution of diplopia after 33 years
A 54-year-old male presented to our department with a right-sided chemosis, periorbital swelling and was systemically unwell. Clinically, his visual acuity was 6/12 in his right eye and 6/6 in his left eye. He had an obvious right enopthalmos. He reported that he had surgery on a fractured right orbit 33 years ago and had had persistent diplopia since. He had never had any infective episode previously.\nHe was treated with systemic and topical antibiotics. On review he reported that his diplopia had worsened, but clinically his eye and swelling was much improved. A CT scan (Fig. ) showed: ‘A 17 mm defect in his right orbital floor. A (silastic) implant was displaced, lying vertically in the saggital plane. It protrudes through the orbital defect into the medial orbit. The inferior rectus is prolapsed through the orbital floor. Inferior and medial recti are both trapped by the implant’.\nA decision was made to remove the implant surgically via a Caldwell–Luc approach. This was performed successfully.\nWithin 4 weeks of surgery, the patient reported that his diplopia had resolved, for the first time, in 33 years. His visual acuity was 6/6 in both eyes.\nThe treatment of orbital floor fractures with silastic sheet is well documented and there are large case series published []. However, there is a high complication rate when using silastic as a material to repair orbital floor fractures. Complications include: implant migration to the skin and the maxillary sinus, skin fistula, persistent diplopia, communication between the orbit and the sinus, periorbital cellulitis []. 13.8% of patients required surgery to remove the silastic at 20 years [].