Severe Hypertropia and Inferior Rectus Edema Due to Delayed Trap-Door Orbital Fracture Repair
Purpose
To present the importance of recognizing trap door orbital fractures with inferior rectus entrapment by examining outcome in the delay of fracture repair in a 15-year-old male and the management of subsequent complications of hypertropia and inferior rectus edema.
Methods
Case report
Results
After undergoing delayed trap door orbital fracture repair 4 days post injury, the patient developed a severe right hypertropia with inability to infraduct the eye one day postoperatively. CT scan showed a massively swollen inferior rectus. He was started on a Medrol dose pack, which subsequently lead to a reduction in edema. Despite improvement over the next couple of months, his diplopia persisted, leading to a right inferior rectus exploration and resection of 4 mm for a 10 diopter right hypertropia 7 months after the initial injury. Surgery led to the resolution of diplopia.
Conclusion
This case demonstrates the importance of recognizing trap door orbital fractures in the emergency department in order to expediently refer the patient to surgery and minimize further complications. However, this case also displays that aggressive care can still lead to a good outcome, even when an entrapped muscle is missed.