"Functional Outcomes of Late Post-Traumatic Enophthalmos Correction".

TITLE: Functional Outcomes of Late Post- Traumatic Enophthalmos Correction BACKGROUND:: Post-traumatic enophthalmos has debilitating functional consequences resulting in restriction of ocular motility and diplopia. Surgical correction aims to restore the globe position and ultimately improve function. This study evaluates the functional outcome of post-traumatic enophthalmos repair.

METHODS: Patients included in this study had post-traumatic enophthalmos and diplopia requiring enophthalmos repair. Diplopia was graded from 0 (no diplopia) to 4 (constant diplopia) based on the Functional Diplopia Grading Scale. Limitations of eye movements were recorded in the vertical, horizontal and torsional directions. Data were gathered prospectively at pre-operative assessment, post enophthalmos repair, and final follow up.

RESULTS: Between 2002 and 2014, 41 patients fulfilled inclusion criteria. Substantial functional improvement, defined as a decrease of ≥ 1 grade of diplopia, was achieved in 65.9% of patients (27 out of 41) after all surgical interventions. Patients with residual diplopia (34/41) after enophthalmos surgery were managed with secondary strabismus surgery (10/34) and or prism glasses (4/34). After all interventions, vertical restrictions improved from μ=-1.95 (σ=1.13) to μ=-1.06 (σ=0.98). Horizontal restrictions improved from μ=-0.88 (σ=0.62) to μ=0.59 (σ=0.6). Adequate clinical correction of enophthalmos to within 2 mm of contralateral globe was achieved in 37 of 41.

CONCLUSIONS: This is the largest case series evaluating functional outcomes of patients undergoing post-traumatic delayed enophthalmos repair. A multidisciplinary care approach resulted in improved globe position, eye movement, and improvement of diplopia. Further studies with larger sample sizes are needed to better understand and treat this important and challenging problem.