Page 121 - Advanced concepts in orbital wall fractures

2. Surgery should not be performed in anticipation of expected posttraumatic complications, such as persistent diplopia or enophthalmos. The patient should be informed that improvement is possible for up to 12 months, and the risk of late enophthalmos, even in large fractures, is minimal.
3. If enophthalmos does occur, surgery may still be indicated.
Conclusion
A nonsurgical approach is a safe treatment strategy for most orbital
floor and/or medial wall fractures, and may prevent surgery-related complications. It is important to perform repeated quantitative evaluation
of ocular motility in the first 3 months after trauma, with the most expected improvement in the first 2 weeks. Immediate indications aside, surgery is
only recommended for insufficiently improved orthoptic measurements
or early development of enophthalmos. Improvement is observed up
to 12 months in binocular single vision, ductions, and the subjective
experience of diplopia. A multidisciplinary approach is important to
achieve the highest standard of care and to gain more insight into the C complex recovery of these fractures. Future prospective research should 6 be focused on quantitative measurements combined with subjective
outcomes.
Clinical perspective
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