Orbital Hypertelorism: A Systematic Review of Techniques, Outcomes, and Complications

Introduction: Patients with OHT have increased interorbital distance which can impede social assimilation and lead to ocular morbidity. Due to its rare occurrence, most studies on this subject are limited to case series and single-institution reports. Given this paucity of data, we conducted a systematic review to aggregate results of OHT correction. Methods: A systematic review was performed according to PRISMA guidelines using Medline and Embase databases. Twenty studies were eventually included in the study. Included papers were retrospective cohort or case series which examined patients who underwent surgical correction of OHT. Results: Twenty papers comprising of 613 patients were included in our study. The average age of surgery was 9.8 years old. 411 patients had reported pre-operative inter-dacryon distance, which was on average 36.78 mm. 283 patients had a reported immediate post-operative inter-dacryon distance of 21.24 mm on average. Long-term follow up, defined as at least 1-year post-operatively, found an average inter-dacryon distance of 22.0 mm among 327 patients. Patients undergoing box osteotomy had an average pre-operative distance of 37.37 and 25.85 mm on long-term follow-up, with a relapse rate of 20.5%. Patients undergoing facial bipartition had an average pre-operative distance of 39.47 mm a long-term follow-up distance of 30.03 mm, with a relapse rate of 15.5%. Complications were reported in 492 patients from 13 studies. The overall complication rate was 24.4% (n = 120). CSF leak was the most common complication (7.5%, n = 37), followed by osteomyelitis/infection (4.7%, n = 23), and strabismus (3.0%, n = 15). There was a 0.6% mortality rate (n = 3). Conclusion: OHT is a complex surgical issue with controversy regarding correction and recurrence. Our systematic review summarizes the current quantitative data regarding demographics, methods of correction, degree of correction, complications, and ocular morbidity.