Impact of surgical timing of postoperative ocular motility in orbital blowout fractures

Br J Ophthalmol. 2018 Mar;102(3):398-403. doi: 10.1136/bjophthalmol-2017-310312. Epub 2017 Jul 25.


Purpose: To investigate the surgical timing postinjury in regard to ocular motility in patients with orbital-floor blowout fractures.

Methods: This study involved 197 eyes (92 right eyes and 105 left eyes) of 197 patients (154 males and 43 females, mean age: 29.0 years, range: 7-85 years) with pure orbital blowout fractures. All patients underwent surgical repair within 30 days postinjury and were followed up for 3 months or more postoperative (mean follow-up period: 8.4 months, range: 3-59 months). Orbital blowout fractures were classified into one of three shapes: (1) trap-door fracture with muscle entrapment, (2) trap-door fracture with incarcerated tissue and (3) depressed fragment fracture. Ocular motility was estimated by percentage of Hess area ratio (HAR%) on the Hess chart at the final follow-up examination. In addition, correlations between postinjury surgical timing and HAR% were analysed.

Results: The mean postinjury surgical timing was 10.7±7.8 days (range: 0-30 days). The mean postoperative HAR% (92.9%±10.5%) was significantly improved compared with preoperative HAR% (73.5%±21.7%) (p<0.01). The mean postoperative HAR% (98.3%±4.4%) of the orbital-floor trap-door fracture patients with incarcerated tissue who underwent surgical repair within 8 days postinjury was significantly better than that of the patients who underwent surgical repair after 8 days (94.2%±5.8%) (p<0.01).

Conclusions: Patients with orbital-floor trap-door blowout fractures with incarcerated tissue that were repaired within 8 days postinjury had better outcomes than those repaired after 8 days, and HAR% is a useful method to record orbital fracture surgical outcomes.

Keywords: orbital blowout fracture; percentage of hess area ratio (HAR%); surgical timing.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Eye Movements / physiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Ophthalmologic Surgical Procedures*
  • Orbital Fractures / physiopathology
  • Orbital Fractures / surgery*
  • Retrospective Studies
  • Time-to-Treatment*