Orbital wall fractures are frequently encountered in clinical practice, however, the indications for surgical treatment still remain controversial. The appropriate treatment strategy is determined taking into consideration the age and general condition of the patient, the severity of diplopia, and the degree of strangulation of the extraocular muscles in individual cases. Herein, we report a case of medial orbital wall fracture which improved with conservative treatment, however, the patient presented with recurrent diplopia about 5 months later.
A 51-year-old woman presented to our hospital with diplopia after sustaining injury in a bicycle accident the previous day. Computed tomography (CT) showed a left medial orbital wall fracture. Magnetic resonance imaging (MRI) showed no strangulation of the extraocular muscles, therefore, the patient was managed by conservative treatment. The symptoms improved by day 3, and ophthalmological examination showed that the restricted movements of the left eye had recovered. However, approximately 5 months after the injury, the patient became aware of diplopia again and visited our hospital. Ophthalmologic examination revealed that the restricted movements of the left eye again, but CT and MRI showed no remarkable changes as compared to the previous imaging findings. Since conservative treatment appeared to be ineffective, endoscopic reduction of the medial orbital wall fracture was performed, with prompt resolusion of the diplopia immediately after the operation.
The present case was a rare case of late relapse of diplopia after initial improvement with conservative treatment, in which it was difficult to judge the surgical indication and the appropriate timing of surgery.
