Background: Titanium mesh is one of the most used reconstruction material in the management of orbital floor fracture, with successful reported outcomes. Few reports describe unfavorable tissue reaction to titanium mesh with subsequent diplopia and lid retraction secondary to periorbita adhesions, or as mentioned in literature, orbital adhesion syndrome (OAS). However, there is no accurate description of such condition and how to avoid it.
Aim: This manuscript was made in an attempt to review characterization of this syndrome, associated risk factors, and recommendations to avoid it.
Patients and methods: A thorough revision of orbital floor fracture cases treated with titanium mesh in oral and maxillofacial surgery units in both Cairo University and Ain Shams University between 2015 and 2017 was done according to criteria described by Lee (2009).
Results: Only six cases of 100 cases treated with titanium mesh in the orbital floor and/or medial wall were diagnosed clinically and radiographically as OAS. All cases underwent removal of implant (3–6 months) after primary repair with replacement by polydaxon sheet. Four cases showed clinical improvement in ocular motility within 2 weeks, whereas two cases did not improve.
Conclusion: OAS is an unfavorable tissue reaction to rough surface of titanium mesh, where delayed primary repair and use of large mesh with wide pores in an un-intact periorbita extending to inferior orbital rim are main risk factors. Early detection of this rare complication with removal of titanium mesh is essential for successful management.