the treatment of orbital floor fractures with silastic sheet was prominent , until the advent of the titanium plate .
it was an adequate treatment ; however , it had a tendency to migrate through the skin .
diplopia when present for months tends to be difficult to resolve surgically , and what makes this case unique is that diplopia has resolved after > 30 years .
a 54-year - old male presented to our department with a right - sided chemosis , periorbital swelling and was systemically unwell .
clinically , his visual acuity was 6/12 in his right eye and 6/6 in his left eye .
he reported that he had surgery on a fractured right orbit 33 years ago and had had persistent diplopia since .
he reported that his diplopia had worsened , but clinically his eye and swelling was much improved . a ct scan ( fig . 
inferior and medial recti are both trapped by the implant. 
 figure  1:coronal slice of ct scan demonstrating silastic sheet protruding through the right orbital floor .
a decision was made to remove the implant surgically via a caldwell  luc approach .
the patient reported that his diplopia had resolved , for the first time , in 33 years .
the treatment of orbital floor fractures with silastic sheet is well documented and there are large case series published . however , there is a high complication rate when using silastic as a material to repair orbital floor fractures .
complications include : implant migration to the skin and the maxillary sinus , skin fistula , persistent diplopia , communication between the orbit and the sinus , periorbital cellulitis .
the treatment of the fractured orbital floor has advanced over the last 30 years . computerized tomography , custom made implants , resorbable and non - resorbable implants , the use of endoscopic surgery   and stereolithography all have an important role in the treatment of the fractured orbital floor .
silastic complications may develop late and the latest published resolution of diplopia following surgery is 20 years .
we feel that our patient is fairly remarkable , in that his diplopia has resolved at 33 years after initial surgery .
 a 54-year - old male sustained a fractured right orbital floor 33 years ago , which was treated with a silastic implant . 
 his diplopia never resolved , and he presented to us with an acute orbital cellulitis . 
 computerized tomography showed a displaced inferior rectus and entrapment of both inferior and medial recti . 
 the implant was removed surgically via a caldwell  luc approach and his diplopia completely resolved after 33 years . 
INTRODUCTION
CASE REPORT
DISCUSSION