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Surgical Timing and Fracture Type on the Outcome of Diplopia After Orbital Fracture Repair

Yu, De-Yi MD; Chen, Chih-Hao MD; Tsay, Pei-Kwei PhD; Leow, Aik-Ming MBBS, FRCS, MS (Plast Surg); Pan, Chun-Hao MD; Chen, Chien-Tzung MD

doi: 10.1097/SAP.0000000000000726
Clinical Papers

Background Orbital fractures and the concomitant soft tissue injuries within the bony orbit result in well-recognized complications such as diplopia and enophthalmos. Guidelines for timing and indications for surgery for achieving an optimal outcome remain elusive. This study examined the effects of timing and fracture type on the outcome of orbital fracture repair.

Material and Methods Data on 255 patients treated for orbital fractures were retrospectively reviewed to determine the effects of the facial bones involved in the fractures, the types of orbital wall fracture, the timing of surgical repair, and diplopia evident before and after corrective surgery on surgical outcomes.

Results The incidence of posttraumatic diplopia increased with the number of orbital wall fractures (P < 0.001). The rate of diplopia resolution after corrective surgery was slow in the first 3 months irrespective of the severity of orbital wall fracture. The diplopia resolution rate for type I orbital wall fractures was significantly higher than that for type II and type III fractures. Patients treated within 2 weeks of sustaining an orbital fracture exhibited a higher diplopia resolution rate than did patients treated 2 to 4 weeks and more than 4 weeks after sustaining the fracture (58% vs 38.1%).

Conclusions A higher number of orbital wall fractures are associated with a higher incidence of diplopia and a poorer long-term result. The timing of surgical repair influences the diplopia outcome. Performing corrective surgery for orbital fractures with diplopia after 2 weeks tends to result in a slower complete recovery rate.

From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung; †Craniofacial Center, Chang Gung Memorial Hospital at Taoyuan; ‡College of Medicine, Chang Gung University, Taoyuan; §Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Linkou; ∥Center for Biostatistics, Chang Gung University, Taoyuan, Taiwan; and ¶Elegant Plastic Surgical Centre, Ipoh, Perak, Malaysia.

Received October 14, 2015, and accepted for publication, after revision November 30, 2015.

Conflicts of interest and sources of funding: none declared.

Reprints: Chien-Tzung Chen, MD, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, No. 222, Maijin Rd, Anle Dist, Keelung City 204, Taiwan. E-mail:

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