Predicting late enophthalmos: Differences between medial and inferior orbital wall fractures

The purpose of this study was to compare the strength of the relationships between predictors and late-onset enophthalmos in medial and inferior orbital wall fractures and to determine the most significant predictive factor of enophthalmos in medial or inferior orbital wall fracture.

Sixty-three adult patients with unilateral medial or inferior orbital wall fracture who had been left untreated for more than two months were enrolled in this study. Patients who had accompanying multiple orbital wall fractures and those with orbital-zygomatic fractures were excluded. Orbital defect area and herniated muscle and fat volumes were evaluated using computed tomography. The degree of enophthalmos was measured using a Hertel exophthalmometer.

Herniated muscle and fat volumes were positively correlated with defect area in the medial orbital wall fracture but showed no positive correlation with inferior orbital wall fracture. In the medial orbital wall fracture group, enophthalmos was positively correlated with defect area and herniated muscle and fat volumes. Defect area was more highly related to enophthalmos than other analyzed metrics. The defect area predictive of enophthalmos was 1.98 cm². However, enophthalmos was positively correlated only with herniated fat volume in inferior orbital wall fracture. The herniated fat volume predictive of enophthalmos was 343.50 mm³.

Orbital defect area in medial orbital wall fracture and herniated fat volume in inferior orbital wall fracture were the most significant predictors of late-onset enophthalmos.