Outcomes and impacts of blow-out fractures of the orbit

Abstract

A blow-out fracture of the orbit is defined as one with orbital wall and or floor fracture without orbital rim involvement. The management of this injury and its timing continue to be a matter of some debate. One of the main reasons for this debate is the lack of unifying objective, quantitative, clinical measures of diplopia severity that encompass both the clinical and patient perspectives. This thesis consists of two distinct studies: one study examines the factors associated with outcome of blow-out fractures, whilst the other examines the patient perspective and experience of this type of fracture. The aim of this thesis is to study the impacts and determine the factors that influence management outcomes with regard to diplopia. A combination of retrospective data and qualitative data was used to help achieve this aim. The retrospective study demonstrated binocular single vision assessment to be a valuable tool in assessing management outcome. In addition, the data demonstrate it has a significant prognostic value in blow-out fractures of the orbit: lower pre-operative diplopia scores, the more chance of improvement in diplopia scores after surgery. Lower pre-operative diplopia scores were associated with a longer follow up time and a greater number of follow up visits required. Demographic factors, surgical timing, type of surgical approach and surgical implant material were shown to have no significant influence on diplopia. Orbital fat herniation in the absence of orbital muscle involvement, as determined by CT scan interpretation, appears to have no significant influence on diplopia when compared to fractures where no tissue herniation was observed on diplopia scores in blow-out fractures. The impact of blow-out fractures from the patient’s perspective was reflected through distress and frustration which negatively influence patients’ daily activities, including their employment. This distress and frustration was reported to centre around the individual’s fear of losing their vision. This misconception appears to be due to potentially ineffective patientclinician communication.