The syndrome of enlarged orbits

Combined orbital fractures cause hematomas and subsequent rigidity of the ligament apparatus around the inferior rectus muscles, while the few true blow-out fractures may lead to an adherence of connective tissues to the floor. The authors describe a third mechanism: Enlargement of the orbit impairs motility, especially the elevation of the globe: Diagnostic pressing of the orbital, parabulbar contents improves elevation. In 9 such cases that were free of the two other knows mechanisms motility was improved by reducing orbital volume. This was performed by implants (4 cases), by instillation of hydroxylapatite (4 cases) or by re-resection of the bony frame (1). Subsequent muscle surgery, if at all necessary, gave truly satisfactory results.