Surgery or Symptom-Based Management? Resolving the 50-Year Debate on Orbital Blowout Fractures

Area of Science:

• Ophthalmology
• Plastic Surgery
• Trauma Surgery

Background:

• The management of asymptomatic orbital blowout fractures is debated.
• Current practice often relies on radiological findings, not solely symptoms.

Purpose of the Study:

• To evaluate a symptom-based protocol for managing orbital blowout fractures.
• To determine if radiological criteria can be disregarded in favor of clinical symptoms.

Main Methods:

• A prospective, single-center study included adult patients with unilateral, isolated blowout fractures.
• Surgical recommendations were based on diplopia, restricted eye movements, or >2 mm globe malposition (GMP).
• Outcomes and patient satisfaction were assessed over 9 months, comparing surgical intervention rates to historical data.

Main Results:

• A symptom-based protocol reduced reconstruction rates from 41.6% to 17.0%.
• The non-surgical group reported lower rates of diplopia (13% vs. 63%) and paresthesia (19% vs. 39%) compared to the surgical group.
• Patient satisfaction with diplopia was significantly higher in the non-surgical group (97% vs. 64%).

Conclusions:

• A symptom-based approach is a safe and effective strategy for orbital blowout fractures.
• Late, subjectively disturbing globe malposition is rare in asymptomatic fractures.
• Ocular function often improves spontaneously without surgical intervention.