Prospective Randomized Controlled Pilot Study on Orbital Blowout Fracture.

Area of Science:

• Ophthalmology
• Plastic Surgery
• Radiology

Background:

• Conflicting recommendations exist for managing blowout fractures (BOF).
• A prospective randomized study is needed to clarify optimal care strategies.
• This study investigates CT findings predicting outcomes in BOF patients.

Purpose of the Study:

• To evaluate CT findings predicting late functional and cosmetic symptoms in BOF patients with ≥1.0 mL orbital content herniation.
• To determine which BOF patients benefit from surgery versus observation.

Main Methods:

• A prospective randomized pilot study involving 26 BOF patients with ≥1.0 mL herniation.
• Patients were randomized to observational (n=10) or surgical (n=16) groups.
• Follow-up for functional and cosmetic symptoms for at least 1 year, correlating CT measurements with clinical findings.

Main Results:

• All 5 patients with inferomedial BOF and ≥1.3 mL herniation in the observational group developed cosmetic deformities and required surgery.
• Inferior BOF patients in the observational group had varied outcomes; some developed deformities, others did not.
• Surgical outcomes were similar across operated patients; diplopia decreased, but surgery potentially induced infraorbital nerve hypoesthesia.

Conclusions:

• Inferomedial BOF with significant herniation warrants surgical consideration to prevent visible deformities.
• Diplopia in BOF without motility limitation may be due to edema and not necessarily an indication for surgery if it resolves.
• CT findings are crucial for predicting outcomes and guiding treatment decisions in BOF management.