BACKGROUND: An orbital floor fracture ("blowout fracture") is caused by direct trauma to the globe, which causes an increase in intraorbital pressure and decompression via fracture of the orbital floor. When the bony rim of the eye remains intact, but the paper-thin floor of the eye socket cracks or ruptures, a small defect in the floor of the eye socket may result, trapping part of the inferior rectus and its surrounding structures. The injury may then result in a restriction of motility and diplopia. Most blowout fractures are caused by an impact to the front of the eye from something bigger than the eye opening, such as a baseball, a clenched fist, or a dashboard.
CASE REPORT(S). A 25-year-old Hispanic male with a recent history of eye trauma presented with diplopia at distance on left gaze. The patient was the victim of a violent street attack two months prior during which he sustained a blowout fracture to his left eye. No diplopia was experienced after the attack. However, after a blowout repair surgery was performed two weeks previous, the patient noted the onset of diplopia. The patient reported that the diplopia was improving, albeit slowly. The patient showed a mild left eye abduction deficiency. All other findings, including screening visual fields, were unremarkable, and the patient’s best-corrected visual acuities were 20/20 in both eyes. An opaque film over his left spectacle lens alleviated the patient’s diplopia. Upon a one month follow-up, the patient reported no improvement in diplopia. The patient was advised to monitor for any changes in symptoms and to return for a progress evaluation in three weeks.
CONCLUSIONS. A blowout fracture surgical repair is undertaken after trauma to alleviate a persistent diplopia, yet it is unusual for the surgery to produce a diplopia that did not exist before. Our conclusion is that there was damage to the left sixth nerve, which developed post-trauma or post-surgery. As the post-surgical edema subsides, a tincture of time may be what is needed for the resolution of the diplopia.