Abstract
Purpose
The management of orbital blowout fractures (BOFs) is controversial: the evaluation of diplopia is the most important criterion for planning whether to undertake surgery.
Our aim was to determine CT findings that may suggest the presence of diplopia when patients with BOFs cannot be adequately examined to plan an orbital repair.
Method and materials
We retrospectively evaluated CT of all patients presented to our Emergency Department for blunt craniofacial trauma (N = 3334) from January 2014 to March 2016, selecting patients with CT-demonstrated BOFs.
The following CT variables were assessed: fracture location, fracture multifocality, bone fragments displacement, extraocular muscles (EOM) thickening, EOM entrapment, EOM displacement, EOM hooking, intraconal and extraconal emphysema, intraconal and extraconal hematoma, and fat herniation.
All patients underwent Hess-Lancaster test, to establish the presence of diplopia.
After performing group comparison with Pearson χ2 test, we derived our prediction model by using logistic regression, with diplopia as the prediction and CT variables as predictors.
Results
We observed 299 patients with BOFs, 46 (15.4%) with a Hess Lancaster test-proven diplopia.
The CT variables with statistically significant difference between the group with diplopia and the group without diplopia were as follows: floor fracture (p = .014), bone fragments displacement (p = .001), multifocality (p = .005), EOM thickening (p = .001), EOM entrapment (p < .001), EOM displacement (p < .001), fat herniation (p = .003).
The CT variables with significance as predictors of diplopia at multivariate analysis were as follows: orbital floor fracture (p value 0.015; odds ratio 2.871, 95% confidence interval of odds ratio 0.223–6.738), EOM displacement (p value 0.001; odds ratio 10.693, 95% confidence interval of odds ratio 3.761–30.401), EOM entrapment (p value 0.001; odds ratio 11.510, 95% confidence interval of odds ratio 3.059–43.306).
Conclusion
The presence of diplopia can be suggested on the basis of CT findings after an orbital trauma.
Similar content being viewed by others
References
Joseph JM, Glavas IP (2011) Orbital fractures: a review. Clin Ophthalmol 5:95–100
Bruneau S, De Haller R, Courvoisier DS, Scolozzi P (2016) Can a specific computed tomography-based assessment predict the ophthalmological outcome in pure orbital floor blowout fractures? J Craniofac Surg 27(8):2092–2097
Bartoli D, Fadda MT, Battisti A, Cassoni A, Pagnoni M, Riccardi E, Sanzi M, Valentini V (2015) Retrospective analysis of 301 patients with orbital floor fracture. J Craniomaxillofac Surg 43:244–247
Furuta M, Yago K, Iida T (2006) Correlation between ocular motility and evaluation of computed tomography in orbital blowout fracture. Am J Ophthalmol 142(6):1019–1025
Egbert JE, May K, Kersten RC, Kulwin DR (2000) Pediatric orbital floor fracture: direct extraocular EOM involvement. Ophthalmology 107:1875–1879
Jordan DR, Allen LH, White J, Harvey J, Pashby R, Esmaeli B (1998) Intervention within days for some orbital floor fractures: the white-eyed blowout. Ophthal Plast Reconstr Surg 14:379–390
Burnstine MA (2003) Clinical recommendations for repair of orbital facial fractures. Curr Opin Ophthalmol 14:236–240
Hawes MJ, Dortzbach RK (1983) Surgery on orbital floor fractures. Influence of time of repair and fracture size. Ophthalmology 90:1066–1070
Jung H, Byun JY, Kim HJ, Min JH, Park GM, Kim HY, Kim YK, Cha J, Kim STJ (2016) Prognostic CT findings of diplopia after surgical repair of pure orbital blowout fracture. Craniomaxillofac Surg 44(9):1479–1484
Yano H, Suzuki Y, Yoshimoto H, Mimasu R, Hirano A (2010) Linear-type orbital floor fracture with or without EOM involvement. J Craniofac Surg 21(4):1072–1078
Koide R, Ueda T, Takano K, Tsuchiya A, Totsuka N, Inatomi M (2003) Surgical outcome of blowout fracture: early repair without implants and the usefulness of balloon treatment. Jpn J Ophthalmol 47(4):392–397
Hoşal BM, Beatty RL (2002) Diplopia and enophthalmos after surgical repair of blowout fracture. Orbit 21(1):27–33
Biesman BS, Hornblass A, Lisman R, Kazlas M (1996) Diplopia after surgical repair of orbital floor fractures. Ophthal Plast Reconstr Surg 12(1):9–16 discussion 17
Harris GJ, Garcia GH, Logani SC, Murphy ML (2000) Correlation of preoperative computed tomography and postoperative ocular motility in orbital blowout fractures. Ophthal Plast Reconstr Surg 16(3):179–187
Tahiri Y, Lee J, Tahiri M, Sinno H, Williams BH, Lessard L, Gilardino MS (2010) Preoperative diplopia: the most important prognostic factor for diplopia after surgical repair of pure orbital blowout fracture. J Craniofac Surg 21(4):1038–1041
Matsunaga K, Asamura S, Morotomi T, Wada M, Wada Y, Nakamura N, Isogai N (2011) Association between preoperative inferior rectus EOM swelling and outcomes in orbital blowout fracture. J Craniomaxillofac Surg 39(7):509–514
Jin HR, Lee HS, Yeon JY, Suh MW (2007) Residual diplopia after repair of pure orbital blowout fracture: the importance of extraocular EOM injury. Am J Rhinol 21(3):276–280
Grant JH 3rd, Patrinely JR, Weiss AH, Kierney PC, Gruss JS (2002) Trapdoor fracture of the orbit in a pediatric population. Plast Reconstr Surg 109(2):482–489 discussion 490-5
Okinaka Y, Hara J, Takahashi M (1999) Orbital blowout fracture with persistent mobility deficit due to fibrosis of the inferior rectus EOM and perimuscular tissue. Ann Otol Rhinol Laryngol 108(12):1174–1176
Anda S, Elsås T, Harstad HK (1987) The missing rectus: a CT observation from blow-out fracture of the orbital floor. J Comput Assist Tomogr Sep-Oct 11(5):895–897
Roth A, Desmangles P, Rossillion B (1999) Early treatment of secondary EOM restriction due to orbital blow-out fractures. J Fr Ophtalmol 22(6):645–650
Hoşal BM, Beatty RL (2002) Diplopia and enophthalmos after surgical repair of blowout fracture. Orbit 21(1):27–33
Mansour TN, Rudolph M, Brown D, Mansour N, Taheri MR (2017) Orbital blowout fractures: a novel CT measurement that can predict the likelihood of surgical management. Am J Emerg Med 35(1):112–116
Gilbard SM, Mafee MF, Lagouros PA, Langer BG (1985) Orbital blowout fractures. The prognosticsignificance of computed tomography. Ophthalmology 92(11):1523–1528
Shah HA, Shipchandler TZ, Sufyan AS, Nunery WR, Lee HB (2013) Use of fracture size and soft tissue herniation on computed tomography to predict diplopia in isolated orbital floor fractures. Am J Otolaryngol 34(6):695–698
Rhee SH, Kim TS, Song JM, Shin SH, Lee JY (2014) Effectiveness of computed tomography for blow-out fracture. Maxillofac Plast Reconstr Surg 36(6):273–279
Putterman AM (1991) Management of blow out fractures of the orbital floor. III. The conservative approach. Surv Ophthalmol 35(4):292–298
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest..
Rights and permissions
About this article
Cite this article
Cellina, M., Floridi, C., Panzeri, M. et al. The role of computed tomography (CT) in predicting diplopia in orbital blowout fractures (BOFs). Emerg Radiol 25, 13–19 (2018). https://doi.org/10.1007/s10140-017-1551-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10140-017-1551-1