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    Thoughts on Orbital Floor Fracture Repair

    I write in response to “Orbital Floor Fracture Repair: When Less Is More” (Clinical Update, February).

    The oft-quoted Yogi Berra once said, “This is like déjà vu all over again.” I had this experience when I read this article. As a resident at the Jules Stein Eye Institute in 1978, I fought the same battle in the emergency room with the plastic surgery and ENT residents over orbital floor fracture repair. I would be called to see a patient in the ER with orbital trauma and would ask him to schedule a follow-up in the eye clinic in a week. These patients would rarely show up for their appointments, and I finally learned that they had been intercepted by plastics or ENT and taken to surgery.

    I recently spoke to Albert Dal Canto, who coauthored “Comparison of Orbital Fracture Repair Performed Within 14 Days Versus 15 to 29 Days After Trauma,”1 and he stated that he not infrequently does surgery to attempt to repair the complications of early orbital fracture repair performed by nonophthalmologists.

    There is a growing multidisciplinary movement called “Choosing Wisely,” in which the members of a number of specialties were asked to identify five tests or procedures that are at best unnecessary and at worst harmful to the patient. The Academy responded with a list including preoperative medical tests, imaging studies, antibiotics for pink eye and for eye injections, and punctal plugs for dry eye.2 I would add a sixth item, which would be not to perform urgent orbital fracture repair except in infrequent conditions such as the white-eyed blowout. We need to educate our nonophthalmology colleagues on the proper approach to orbital fractures both on an individual and a professional-society level.

    Roger P. Harrie, MD 
    Salt Lake City 

    ___________________________

    1 Dal Canto AJ, Linberg JV. Ophthal Plast Reconstr Surg. 2008;24(6):437-443.

    2 Parke DW II et al. Ophthalmology. 2013;120(3):443-444.

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