“Sutureless” Repair of Orbital Floor and Rim Fractures

Abstract

To report on the surgical outcomes of patients undergoing orbital fracture repair without periosteal or conjunctival closure. Retrospective interventional case series. Eighty-two patients (85 eyes) who underwent transconjunctival repair of isolated floor (n = 38) or complex orbital fracture (n = 47) without conjunctival closure. A transconjunctival incision below the tarsus provides preseptal access to the inferior orbital rim, after which the periosteum is incised for exploration and repair of orbital floor fractures. Forced ductions are performed after release of entrapped tissue and placement of an orbital floor implant, and the conjunctiva is reapproximated with forceps and draped into the inferior fornix. Incidence of postoperative complications, including orbital implant exposure, infection, and migration. Patients were followed for an average of 318 days postoperatively (range 82-978 days). One patient experienced a pyogenic granuloma at the conjunctival incision that resolved with steroid drops. Other complications included lateral canthal dystopia or pyogenic granuloma at the lateral canthotomy site, when used. There were no cases of postoperative implant exposure, infection, or migration. Forgoing closure of the periorbita and conjunctiva after transconjunctival orbital floor and rim fracture repair is associated with a low incidence of postoperative complications. This technique is applicable in the repair of both isolated floor fractures and complex orbital fractures. The authors have no proprietary or commercial interest in any material discussed in this article.