Orbital Fracture Surgery

I am really worried about my predicament. About 4 months ago, I took an elbow to the face. I went to the emergency room and an opthamologist, and both said that even though I had double vision in my eye, it should return to normal with the reduction of the swelling.

Well I got a CT scan, and I went to a surgeon who said that it was a blowout fracture and that I should get surgery for an implant to prevent the sunken eye. So a week after my injury, I had surgery to place a sheet under my eye.

What I'm really worried about is that after my surgery (and this seems to be a problem with a lot of people), the eye was positioned a bit upwards, but with time the double vision seemed to progressively get better. It has now been exactly 4 months, but I am STILL getting double vision when I look up, down, or to the far side, and although the eye looks even with the normal one when looking straight, you can tell that it deviates and flips upwards when I look up. This leads me to believe that either I am slow healer and there is still internal swelling under the eye, or my eye muscle got weakened, or that the surgery was done improperly.

I know the eye healing is a bit of a day by day thing, but it seems that the healing has tapered off, and I can't really tell if it's getting better each day. I just don't want it to stop here...

Should I go get a second opinion about the this strabismus/muscle surgery I've been hearing about? What could be the problem? The eye looks normal, and it has returned to the original size - you can't even tell the difference. The weird thing is that the injured eye seems to have a LARGER range of motion, because it is flipped upwards.

Any thoughts?

[John C Hagan III, MD, FACS, FAAO]

You should have followed the ophthalmologists advice. I suspect the person that operated on you was a plastic surgeon. Plastic surgeons generally operate on every blow out fracture ophthalmologists about 30%. Guess what double vision is more common in the plastic surgeon group.

Nothing you can do about that now. See a Eye MD that specializes in eye muscle problmes (strabismus) sometimes called a pediatric ophthalmologist. Find one at www.aao.org

JCH MD