Long-term follow-up of orbital blow-out fractures with and without surgery.

The patients having orbital repair for a blow-out fracture, 6 months or longer after injury, had a high incidence of enophthalmos (72%). This compares badly with 17% in the non-surgical group and 20% of those who had surgery within 14 days of trauma. The residual enophthalmos was minimal in the latter two groups, but could measure 2 or 3 mm in the late surgery group. 40% of the late surgery group also needed additional orbital or muscle surgery and the fields of binocular single vision achieved were only moderately good. The good results achieved without surgery do not, of course, mean that patients with blow-out fractures do equally well regardless of surgical treatment. This study has shown that careful clinical and radiological assessment in the first 10 days permits a reasoned decision to be made whether to operate or not on any particular patient.