Management

• Indications for Surgical Intervention: enophthalmos and/or hypoph-thalmos (>2—3 mm), mechanical entrapment, diplopia, dehiscence of intraorbital tissue, high risk of enophthalmos and/or hypophthalmos (large floor defects)

• Contraindications for Surgical Intervention: hyphema, retinal tear, globe perforation, only seeing eye, sinusitis, frozen globe

• Ophthalmological Evaluation: essential to evaluate for serious and potentially blinding problems (eg, hyphema, dislocated or subluxed cataractous lenses, retinal holes or detachment, or optic nerve contusion)

• Timing: ideally should be completed 7—10 days after swelling has subsided, delayed repair may reveal bone resorption and scar contracture

• Technique: expose orbital rim, medial orbital wall, and floor posteriorly to the junction of the infraorbital canal and inferior orbital fissure; elevate soft tissue from the floor defect; reduce fracture; for significant defects or difficult reductions may reinforce floor with floor grafts (eg, polyethylene [Marlex], gelfilm, or bone for larger defects), typically may repair up to 5 mm of enophthalmos without straining optic nerve

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