How Can My Eye Be Fixed That Has Dropped After Repair Of A Fractured Eye Socket?

Q: Dr. Eppley,  I need some help with an issue. I had an orbital floor fracture repair done a year ago with mesh implant. Since then I now have enophthalmos and nerve damage in my face. I want to know at this point is there anything you can do for me or suggest? PLEASE help me if you can I would greatly appreciate you! 

A: I will assume that you had an isolated orbital floor blow-out fracture. When that occurs, the supporting thin bony floor of the eye drops down. If significant enough (greater than a 1 cm floor defect) the eye will drop down. (enophthalmos) In addition, the large infraorbital nerve runs just under the orbital floor so it frequently gets trapped or pinched as the floor drops down. This is a sensory nerve (maxillary division of the trigeminal nerve) that supplies feeling to the cheek, lip and side of the nose. If injured or entrapped, patients may suffer long-term numbness or pain.

During an orbital floor repair, I always check for this nerve and make sure it is not entrapped in the blow-put fracture. Sometimes the nerve may be irreversibly injured, other times it may be entrapped and needs to be released. Reconstruction of the orbital floor can be done by a wide variety of synthetic implants or bone. There are proponents for all approaches and any of them can work with good surgical technique. The goal of orbital floor reconstruction is to prevent long-term dropping of the eye, known as enophthalmos, due to loss of support.

Since you have enophthalmos and infraorbital nerve dysesthesia, I suspect that further surgery may be beneficial by removal of the mesh implant, exploration and decompression of the nerve and a new floor reconstruction done. The first place to start, however, is with a good CT evaluation. I would get a 3-D CT scan of the involved orbit to first look at the anatomy. Based on that information, surgery can be planned appropriately.

Dr. Barry Eppley

Indianapolis, Indiana