A nonsurgical approach with repeated orthoptic evaluation is justified for most blow-out fractures

Advanced Concepts of Orbital Reconstruction

“…Surgery itself is an additional trauma to the orbit and its contents and should be well indicated and balanced with the anticipated outcomes of nonsurgical or less-invasive treatment options. 30,31 Surgery and reconstruction with orbital implants have a distinct place in treatment of orbital wall fractures. When indicated, orbital implant positioning should be performed as accurately and precisely as possible, to improve bulb position, ocular movements, orbital volumes, and esthetic outcome.…”

Three-Dimensional Computer-Aided Analysis of 293 Isolated Blowout Fractures – Which Radiological Findings Guide Treatment Decision?

“…Up to 10% of unoperated orbital fractures can result in enophthalmos in the affected globe masked by soft tissue swelling 10 . However, Young et al 25 reported a mean residual enophthalmos of 2.1 mm to be clinically irrelevant, and it seems like most non-surgically treated patients don't have aesthetically disfiguring enophtalmos after 12month follow-up 26 . Additionally, enophthalmos can persist even after successful surgery 27 .…”

Orthoptic Evaluation and Treatment in Orbital Fractures

“…4 Unfortunately, only a few articles regarding orbital fractures include a quantitative (orthoptic) evaluation of ocular motility. 4,5,10,11 Not all patients present themselves with typical patterns of diplopia 12 and there is no significant relation between the severity of injury and eventual ocular motility outcome (Case 1). 5,6 Diplopia not always is the first concern of patients, initially noticed, or observed at all.…”