Blow-out fracture of the orbit. Diagnostic and therapeutic considerations, and results in 90 patients treated.

On the basis of 90 patients with blow-out fracture of the orbit the authors present diagnostic methods, the treatment and follow-up results, mainly as regards visual function (diplopia) and aesthetics (enophthalmos). Surgery was performed in 77 cases, 6 patients were treated conservatively by eye muscle training, and 7 patients refused surgery. Surgery consisted in primary reconstruction of the orbit, exploration of the fracture site, freeing the entrapped soft tissues (periorbital tissues, eye muscles) and reconstruction of the defect with autogenous bone graft, followed by eye muscle surgery in cases of failure. After surgery no complications were observed. Results of treatment were evaluated by established methods elaborated by the authors, in the same order before and after surgery. Of 77 patients treated surgically recovery was obtained in 63.6%, marked improvement in 23.4%, slight improvement in 13.0%. In conclusion the authors state that: 1) in all cases ophthalmological examination is most important, 2) approach to the orbital floor or medial wall is best obtained by transconjunctival or subciliary incision, 3) in cases with a defect with a defect of the orbital floor the best material is autogenous bone graft. In linear fracture of the orbital floor and medial wall it is sufficient to free the entrapped tissues, 4) in all surgical patients eye muscle training proved effective.