Orbit

Treatment of postoperative (and post-injury) problems affecting the orbit (eye socket) ranges from the very urgent to long-term, less urgent issues and includes:

Loss of vision. Orbital compartment syndrome (condition arising from increased pressure in the orbital space) is one of a small number of genuine maxillofacial emergencies. In a recently operated patient simply all the sutures closing the wound are removed and whatever is causing the increased pressure is let out. In a traumatic orbital compartment syndrome, a procedure called lateral cantholysis (making an incision around the outside attachments of the eyelids and opening the thick fascia) will allow release of the cause of compression (usually an accumulation of arterial blood). A drain is placed for 24 hours. An avulsed globe (knocked-out eyeball) can not be treated, any direct damage to the optic nerve is regarded as permanent (the fibres of the optic nerve are special, they behave like brain cells).
Disturbance of vision. Change in the position of the globe of the eye or disturbance of the function of the relevant muscles leads to double vision. Correction is aimed at releasing any factors restricting movement of the relevant muscle (usually the inferior rectus muscle). This is usually done by reconstruction of the orbital floor with bone or cartilage grafts, titanium plates or PEEK (synthetic material) implants. In cases where reconstitution of the orbit does not improve vision, opthalmological input is necessary.
Disturbance in sensation . The nerve supplying feeling to the area of cheek below the eye runs in the floor of the orbit. This is a typical area for complex fractures of the cheekbone (zygoma or malar) as the bone in the area is so thin. Altered sensation in this area is common after injury of soft and hard tissue or surgery. ‘Decompressing’ the infra-orbital nerve as part of reducing the fracture may improve recovery. Surgically removing bone around a nerve giving rise to altered sensation may help although the benefits can not be promised. Carbamazepine and gabapentin/pregabalin may help posttraumatic or postoperative neuropathic pain.
Appearance. Basically, leave alone, mostly things settle down. Even ectropion (lower eyelid sagging outward) caused by scarring can improve with time, although scar revision and full-thickness skin graft may be needed.