Risk factors associated with complications of orbital surgery in children

Purpose: To assess the overall complication rate of orbitotomies performed in children and to determine the nature of complication to identify possibl e risk factors. Methods: Thirty children <13 years underwent 33 orbitotomies for space-occu pying lesions of the orbit or orbital decompression. A detailed evaluation of the surgical procedures and outcomes was conducted. Follow up averaged 2 .5 years (range: 6 months to 5 years). Results: The complication rate was 20% (2 of 10 cases) for anterior orbitot omies, 40% (8 of 20 cases) for primary lateral orbitotomies, and 100% (3 of 3 cases) for secondary orbitotomies. Dense amblyopia was noted in 6 of 9 p atients. Major complications were frozen eyeball, diplopia, and ptosis. Les s serious complications were enophthalmos, internal ophthalmoplegia, dry ey e, and eyelid retraction. Six patients underwent extraocular surgery, levat or muscle surgery, or both at a later date. Conclusion: Although the scope of complications is the same in children as in adults, the frequency of cystic benign lesions and small orbits in child ren can cause more frequent serious complications. Additionally, dense ambl yopia of a complicated nature makes visual outcome unpredictable. The most significant risk factors identified were the need for a secondary procedure for recurring pathology and the presence of an intraconal lesion.