Experience of a UK Level One Trauma Centre in Orbital Floor Fractures: A Focus on the Surgical Approach and Lid-Related Complications

Abstract The two surgical approaches to access orbital fractures are transconjunctival and transcutaneous. The aim of this study was to assess the outcomes of orbital repairs with a focus on lid-related complications and their management. A retrospective analysis was carried out over a 5-year period, from January 2015 to January 2020, assessing all consecutive orbital repairs in our unit. Data was collected for variables including demographics, fracture pattern, surgical approach, and details of any post-operative complications. 111 patients were included in the study. 85% were male with majority between 16 to 45 years of age. 40% had isolated orbital floor fractures, 25% zygomaticomaxillary complex and 16% Le Fort pattern fractures. 80% (n = 91) received a trans-conjunctival approach as first choice. In the Trans-conjunctival group, 6.6% had entropion and increased scleral show, 4.4% had ectropion and no canthal mal positioning. In the transcutaneous group there was a higher rate of ectropion (25%) and lower rate of entropion and increased scleral show (5%). Factors associated with higher rate of complications included complex fractures, use of conjunctival sutures and increased length of time to surgery. 72% of patients who suffered entropion required further surgical treatment. The most common complication of the trans-conjunctival approach is Entropion and clinicians should have low threshold for early surgical management. We feel that this should be part of the consenting process especially in high-risk cases.