Orbital fractures in the pediatric population are rare. A trapdoor fracture is a special anatomic type of orbital fracture associated with herniation of orbital contents and entrapment of extraocular muscles entrapment with no signs of any soft tissue trauma. A delay in diagnosis can lead to a life-threatening condition known as oculocardiac reflex, characterized by nausea, vomiting, bradycardia, and syncope. Many authors recommend early surgical intervention, but some patients may delay for various reasons. We hereby represent three cases of orbital fracture to prevent long-term persistent diplopia. Depending on the case scenario, two cases were operated on in which an autogenous iliac cortical graft was placed in one patient to prevent postoperative herniation of orbital content, and in one patient, only release of entrapped muscles was done. One patient was managed conservatively with a regular follow-up visit.

UNASSIGNED: Foreign body reaction to non-absorbable alloplastic orbital implants utilized for bony reconstruction are infrequently documented in the literature. We present the workup and surgical management of a giant cystic mass encapsulating a patient\'s alloplastic orbital implant, which was ultimately deemed to be a result of foreign body reaction.
UNASSIGNED: A 41-year-old male patient with distant history of a right orbital floor fracture had undergone repair with the placement of a nylon foil implant. The patient presented twenty years later with progressive ipsilateral globe proptosis and was found to have a giant inferior orbital cyst. Surgical exploration and removal of the implant and capsule were performed. Histopathology confirmed a delayed foreign body reaction around the patient\'s alloplastic implant.
UNASSIGNED: Alloplastic implants may result foreign body reaction and cyst encapsulation as a delayed complication.

Lower eyelid malpositions following transconjunctival repair of the floor and the zygomaticomaxillary complex fractures are rarely observed. The case series includes three patients (mean age, 22 years; 3 males) who developed lower eyelid entropion following orbital fracture repair (two complexes, one isolated type) using titanium mesh (n = 2) or iliac bone grafting (n = 1) through the transconjunctival approach. Entropion repair was attempted with scar release and Jones procedure in one, and posterior lamellar lengthening with mucous membrane graft in two patients. At a median follow-up of 25 months (range, 3-24), two patients had symptomatic relief without any lash globe touch, and one patient had persistent entropion after multiple interventions including failed mucous membrane graft (n = 1), full-thickness blepharotomy with everting sutures (n = 1), and scleral spacer grafting for posterior lamellar lengthening (n = 1). The literature is inconclusive about the association between eyelid malpositioning and any specific implant material, type of fracture, or incision closure technique.

Orbital floor fracture is the most common type of orbit-related injury seen in pediatric age groups. It is also called a white-eyed blowout fracture when the usual signs of orbital fracture-periorbital edema, ecchymosis, and subconjunctival hemorrhage are absent. Several materials are used for orbital defect reconstruction. The most popular and widely used material is titanium mesh. We present a case of a 10-year-old boy with a white-eyed blowout fracture of the floor of the orbit of the left side. The patient had a history of trauma, after which he developed diplopia in the left eye. On examination, his upward gaze was restricted in the left eye, which was suggestive of inferior rectus muscle entrapment. The orbital floor reconstruction was done using a hernia mesh made up of nonresorbable polypropylene material. This case demonstrates the utility of nonresorbable materials in orbital defect reconstruction in pediatric patients. Further studies are needed to better understand the scope of polypropylene-based materials in the floor of orbit reconstruction and their benefits and shortcomings in the long run.

A 59-year-old man with a history of obstructive sleep apnea presented to the emergency department for acute swelling of the left upper and lower eyelids after nose blowing. The patient denied prior orbital trauma or surgery and examinations were unremarkable for bony step-offs, lacerations, enophthalmos, proptosis, hypoglobus, or extraocular muscle restriction. Imaging confirmed the diagnosis of left anteromedial orbital floor defect with periorbital emphysema. The orbital floor fracture repair was successfully performed with a MEDPOR implant (Stryker, Kalamazoo, Michigan) to seal the persistent orbital floor defect. A review of the literature revealed common predisposing factors, including forceful nose blowing, remote history of trauma, mucosal inflammation, and smoking.

UNASSIGNED: Brain abscess is a potentially fatal condition. Orbital fractures caused by penetrating injury may be associated with intracranial infection. Such complication associated with blunt trauma, orbital roof fractures, and odontogenic abscesses is exceedingly rare.
UNASSIGNED: We report the case of a 40-year-old transgender female with a frontal abscess presenting several weeks following a motor vehicle crash from which she suffered multiple facial fractures and an odontogenic abscess. On computed tomography scan, the patient had multiple right-sided facial fractures, including a medial orbital wall fracture and a right sphenoid fracture extending into the superior orbital roof. There was hemorrhage notable in the right frontal lobe. Communication with the ethmoid sinuses likely provided a conduit for bacterial spread through the orbit and into the intracranial and subdural spaces.
UNASSIGNED: Skull base fractures that communicate with a sinus, whether it be frontal, ethmoid, or sphenoid may increase the risk of brain abscess, especially in patients who develop an odontogenic abscess. Surgical repair of the defect is essential, and treating patients prophylactically with antibiotics may be beneficial.

We describe a rare case of cyclotorsion likely secondary to medial rectus and inferior rectus pathology in a patient with orbital trauma. Sequential orthoptic measurements including Hess charts are presented alongside relevant sections of the orbital CT scans over the course of the patient\'s treatment. Following the insertion of a plate to repair an orbital floor fracture, the patient developed cyclotorsion. A combined approach of sequential orthoptic assessment and imaging revealed the likely underlying mechanism. Inferior rectus mechanical restriction combined with displacement of the medial rectus pulley appear to be the likely culprits. Once the orbital plate was exchanged for a smaller sized plate the patient\'s symptoms and clinical features resolved. Although orbital plate malpositioning is not an uncommon event, medial rectus deviation as a cause of cyclotorsion has not previously been described. We discuss the alternative differentials for patients with similar orthoptic findings and how they were excluded.

Orbital fractures may be accompanied with severe damage of the eye bulb and other intraorbital tissues. Early clinical findings can be very mild, therefore it is vital to actively seek not only for any damage done to the soft tissues of the orbit, but also for extraorbital complications such as liquorrhea or meningitis. We report a relatively rare case of blow-in fracture of orbital roof in eleven years old boy. Patient was admitted to the emergency care after falling off a bicycle without impaired consciousness. During admission ophthalmologist evaluated the condition as severe contusion of the left bulb, with hemophthalmia and retinal comotosis. Due to significant swelling of eye lids and periorbital hematoma, it was not possible to perform specific tests to objectify possible oculomotor disorder and diplopia. CT scan findings show dislocated fracture of orbital roof with fragments reaching into the musculus rectus superior. For high risk of bulbus penetration and muscle damage a surgical intervention with bone fragments removal was performed using endoscopic assisted frontal orbitotomy. After operation patient had no signs of functional eye disorder.

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OBJECTIVE: The objective of this study was to determine whether there is a need for ophthalmologists to perform a specialized assessment after the occurrence of orbital fractures.
METHODS: Sixty-three patients (64 orbits) diagnosed with orbital fractures were evaluated preoperatively (up to 24 h after the trauma) and in 90-day postoperative period.
RESULTS: Eight injuries required either specialized clinical or surgical ophthalmologic intervention. Of these patients, four required emergency eye surgery: two patients with corneal lacerations had lesions larger than 2 mm. Two patients had extensive ocular lesions after multiple traumas with uveal exposure and without light perception. Another four patients (iridodialysis associated with lens subluxation, anterior uveitis, direct lesion on the optic nerve, and chorioretinitis sclopetaria) received conservative management.
CONCLUSIONS: This study concluded that a specialized ophthalmologic examination as soon as possible is important, particularly in cases in which the signs and symptoms of severity are associated. The non-ophthalmologist surgeon must have the basic medical knowledge required to provide basic primary ophthalmologic care and to discern the severity of the injury.