Khawaja Khalid Shoaib, Inamul Haq, Kashif Ali, Muhammad Ahsan Mukhtar.
Management of orbital floor fracture with autoclaved x-ray film.
Pak Armed Forces Med J Jan ;58(3):353-6.

A 33 years old lady had a road traffic accident four years back with multiple injuries to left side of head and body including fracture of three ribs which were managed at that time. She presented with persistent diplopia which was very troublesome. There was inferior dystopia (3 mm) and exotropia (30 prism diopters) of left eye ball. She had narrowing of palpebral fissure due to ptosis and inferior lid elevation. Orbital floor was explored through transconjunctival incision with lateral canthotomy and cantholysis under general anaesthesia. Once the inferior orbital rim was reached, an incision was made in the periosteum with sharp edge of a periosteal elevator. An attempt was made to reposit the orbital contents through the floor defect but not much could be done due to fibrotic changes in entrapped tissue. A 7 c m x 3 cm piece of autoclaved X ray film folded upon itself in the form of a spiral (making final size of 3 cm x 1 cm with thickness of 0.3 cm) was placed below the eyeball and stitched to periosteum, to elevate and support the eyeball. Lower lid retractors were stitched with 6/0 vicryl and conjunctiva was closed with 8/0 silk. It corrected the inferior displacement and decreased exotropia to 15 prism diopters for which lateral rectus recession (6 mm) was done. It corrected diplopia in primary position. Prophylactic antibiotic and analgesics were given post-operatively. However four weeks after surgery patient presented with swelling below lateral canthus due to slight anterior displacement of the film. Sharp margin of film was visible in the inferior fornix as it had cut through the conjunctiva.

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