Missed orbital wall blow-out fracture as a cause of post-enucleation socket syndrome

Background Post-enucleation socket syndrome (PESS: deep upper lid sulcus, p tosis or upper lid retraction, enophthalmos and lower lid laxity) is a well -recognised complication of a volume-deficient anophthalmic socket. A patie nt requiring enucleation following severe ocular trauma may have an underly ing orbital wall blow-out fracture which if overlooked can cause severe vol ume deficit with poor cosmesis and limited prosthesis motility. Purpose To establish the prevalence of an undiagnosed blow-out fracture in patients with FESS and a history of relevant trauma. Methods Medical records and orbital computed tomography (CT) scans were rev iewed for all patients presenting with PESS and a history of relevant traum a. Results Undiagnosed blow-out fractures were found in 15 (33%) of 45 patient s presenting between August 1993 and December 1996. These were significant enough to warrant surgical repair in 13 (29%) patients. Conclusions We suggest that any patient presenting with PESS and a history of relevant trauma should be considered to have an orbital wall blow-out fr acture until proven otherwise by CT scanning of the orbit. Similarly any pa tient requiring enucleation following severe ocular trauma should undergo C T scanning to rule out a coexisting blow-out fracture which could be repair ed at the time of enucleation.