Purpose: To evaluate current patient demographics and surgical outcomes from a large series of 733 surgically treated orbital fractures from an ophthalmologist’s perspective. Methods: We reviewed the medical records of 733 patients with orbital fracture, who were treated surgically by one of the authors at Gil Hospital, Gachon University, from May 2000 until September 2007. Data regarding patient demographics, signs and symptoms at presentation, cause of injury, nature of fracture, associated ocular and nonocular injury, surgical outcome and complications were collected. Results: Male patients outnumbered female patients, and blowout fracture occurred most frequently between the ages of 20 and 29 years (mean age 30.7 years). Violent assault was the leading cause of the fractures, followed by fall/slip and traffic accidents. Common signs and symptoms were periorbital ecchymosis, ocular motility restriction, diplopia and enophthalmos. In the pediatric group, diplopia and ocular motility restriction were the most common. Subconjunctival hemorrhage, hyphema and commotio retinae were the most commonly associated ocular injuries. As for the location of fractures, medial wall fractures were the most common, followed by fractures of the inferior wall, and both medial and inferior walls, in order. The most common type of fracture was the ‘comminuted’ one. In the pediatric group, the percentage of trapdoor-type fracture was higher than in the adult group. Forty-four percent of the patients had diplopia preoperatively and 8.7% postoperatively. The average measurement of difference in the enophthalmos (≧2 mm) patient population was improved from 2.62 (±SD 0.9) to 1.73 (±SD 1.3) after surgery. Ocular motility restriction was preoperatively noted in 297 patients (40.5%), and only 18 patients (2.5%) showed restriction after surgery. Conclusion: Young male individuals are at the highest risk for orbital fractures. There are marked differences in the clinical symptomatology and findings between pediatric and adult orbital fractures. Diplopia, enophthalmos and ocular motility restriction improved by repair of fracture.

1.
De Man K, Wijngaarde R, Hes J, de Jong PT: Influence of age on the management of blow-out fractures of the orbital floor. Int J Oral Maxillofac Surg 1991;20:330–336.
2.
Hawes MJ, Dortzbach RK: Surgery on orbital floor fractures: influence of time of repair and fracture size. Ophthalmology 1983;90:1066–1070.
3.
Tong L, Bauer RJ, Buchman SR: A current 10-year retrospective survey of 199 surgically treated orbital floor fractures in a nonurban tertiary care center. Plast Reconstr Surg 2001;108:612–621.
4.
Bansagi ZC, Meyer DR: Internal orbital fractures in the pediatric age group: characterization and management. Ophthalmology 2000;107:829–836.
5.
Courtney DJ, Thomas S, Whitfield PH: Isolated orbital blowout fractures: survey and review. Br J Oral Maxillofac Surg 2000;38:496–504.
6.
Cruz AA, Eichenberger GC: Epidemiology and management of orbital fractures. Curr Opin Ophthalmol 2004;15:416–421.
7.
Folkestad L, Aberg-Bengtsson L, Granstrom G: Recovery from orbital floor fractures: a prospective study of patients’ and doctors’ experiences. Int J Oral Maxillofac Surg 2006;35:499–505.
8.
Gewalli F, Sahlin P, Guimaraes-Ferreira J, Lauritzen C: Orbital fractures in craniofacial trauma in Goteborg: trauma scoring, operative techniques, and outcome. Scand J Plast Reconstr Surg Hand Surg 2003;37:69–74.
9.
Grant JH 3rd, Patrinely JR, Weiss AH, et al: Trapdoor fracture of the orbit in a pediatric population. Plast Reconstr Surg 2002;109:482–489, discussion 90–95.
10.
Hosal BM, Beatty RL: Diplopia and enophthalmos after surgical repair of blowout fracture. Orbit 2002;21:27–33.
11.
Kwon JH, Moon JH, Kwon MS, Cho JH: The differences of blowout fracture of the inferior orbital wall between children and adults. Arch Otolaryngol Head Neck Surg 2005;131:723–727.
12.
Leitch RJ, Burke JP, Strachan IM: Orbital blowout fractures – the influence of age on surgical outcome. Acta Ophthalmol (Copenh) 1990;68:118–124.
13.
Lelli GJ Jr, Milite J, Maher E: Orbital floor fractures: evaluation, indications, approach, and pearls from an ophthalmologist’s perspective. Facial Plast Surg 2007;23:190–199.
14.
Lynham AJ, Chapman PJ, Monsour FN, et al: Management of isolated orbital floor blow-out fractures: a survey of Australian and New Zealand oral and maxillofacial surgeons. Clin Exp Ophthalmol 2004;32:42–45.
15.
Nam SB, Bae YC, Moon JS, Kang YS: Analysis of the postoperative outcome in 405 cases of orbital fracture using 2 synthetic orbital implants. Ann Plast Surg 2006;56:263–267.
16.
Ploder O, Oeckher M, Klug C, et al: Follow-up study of treatment of orbital floor fractures: relation of clinical data and software-based CT-analysis. Int J Oral Maxillofac Surg 2003;32:257–262.
17.
Su GW, Harris GJ: Combined inferior and medial surgical approaches and overlapping thin implants for orbital floor and medial wall fractures. Ophthal Plast Reconstr Surg 2006;22:420–423.
18.
McCord CD, Tanenbaum M, Nunery WR: Oculoplastic Surgery, ed 3. New York, Raven Press, 1995, pp 515–551.
19.
Greenwald HS Jr, Keeney AH, Shannon GM: A review of 128 patients with orbital fractures. Am J Ophthalmol 1974;78:655–664.
20.
Converse JM, Smith B, Obear MF, Wood-Smith D: Orbital blowout fractures: a ten-year survey. Plast Reconstr Surg 1967;39:20–36.
21.
Archer WH: Oral and Maxillofacial Surgery, ed 5. Philadelphia, Saunders, 1975.
22.
al-Qurainy IA, Stassen LF, Dutton GN, et al: The characteristics of midfacial fractures and the association with ocular injury: a prospective study. Br J Oral Maxillofac Surg 1991;29:291–301.
23.
Egbert JE, May K, Kersten RC, Kulwin DR: Pediatric orbital floor fracture: direct extraocular muscle involvement. Ophthalmology 2000;107:1875–1879.
24.
Sires BS, Stanley RB Jr, Levine LM: Oculocardiac reflex caused by orbital floor trapdoor fracture: an indication for urgent repair. Arch Ophthalmol 1998;116:955–956.
25.
Anderson RL: The blepharocardiac reflex. Arch Ophthalmol 1978;96:1418–1420.
26.
Biesman BS, Hornblass A, Lisman R, Kazlas M: Diplopia after surgical repair of orbital floor fractures. Ophthal Plast Reconstr Surg 1996;12:9–16, discussion 7.
27.
Gilbard SM, Mafee MF, Lagouros PA, Langer BG: Orbital blowout fractures: the prognostic significance of computed tomography. Ophthalmology 1985;92:1523–1538.
28.
Iliff N, Manson PN, Katz J, et al: Mechanisms of extraocular muscle injury in orbital fractures. Plast Reconstr Surg 1999;103:787–799.
29.
Burres SA, Cohn AM, Mathog RH: Repair of orbital blowout fractures with Marlex mesh and Gelfilm. Laryngoscope 1981;91:1881–1886.
30.
Nicholson DH, Guzak SW: Visual loss complicating repair of orbital floor fractures. Arch Ophthalmol 1971;86:369–375.
31.
Forrest CR, Khairallah E, Kuzon WM Jr: Intraocular and intraorbital compartment pressure changes following orbital bone grafting: a clinical and laboratory study. Plast Reconstr Surg 1999;104:48–54.
32.
Jung JW, Chi MJ: Temporary unilateral neurogenic blepharoptosis after orbital medial wall reconstruction: 3 cases. Ophthalmologica 2008;222:360–262.
33.
Malhotra R, Selva D, Wormald PJ, Davis G: Video-endoscope assisted teaching during sub-periosteal orbital surgery. Orbit 2005;24:113–116.
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