Blow-out fractures: patterns of ocular motility and effect of surgical repair.

The decision to repair an orbital blow-out fracture depends on several factors, but evidence for the optimum timing of surgery is not clear. We retrospectively studied all patients with orbital injuries who were referred to the eye department at a Scottish teaching hospital over a 10-year period from 1997 to 2006. We aimed to document the incidence and pattern of disturbances of ocular motility after blow-out fractures, and identify the rates of early and late resolution of these deficits, both spontaneously and after surgical repair. We found that most patients with blow-out fractures had a motility defect for an acute phase; approximately one third of which resolved spontaneously within 2 weeks. Recovery of motility after orbital surgery occurred in less than half the patients, and was not immediate. Continuing recovery also occurred in those who did not undergo surgery. Entrapment of muscle or tissue is not the only cause of motility disturbance after blow-out fractures, and orbital surgery is only one aspect of management in those patients with persistent motility defects.