[Orbital wall fracture from the ophthalmologic viewpoint].

The fracture of the orbital wall is characterized by a typical ophthalmological symptomatology, which is repeated more or less completely with each patient. Beside the optic nerve lesion, which is rare, the motility disturbance of the globe is the severest consequence of an orbital wall fracture. It is the ophthalmologist's task to correctly interpret the motility disturbance caused by an orbital wall fracture and to distinguish it from ocular motility disturbances of other origin. Thus he has decisive influence on the indication of an operation. After a short presentation of how an orbital wall fracture comes into being and its connection with a restricted motility of the globe, the diagnostic steps are described. Two questions important for the daily practice are discussed with the help of 161 case histories: 1. the connection between the development of the motility disturbance and the interval between the day of the accident and the day of the operation; 2. the influence of the type of the fracture on the kind and the extent of the motility disturbance and the time required for its complete recovery. It has been observed that the factor time, that is the fastest possible operative revision, does not, as assumed before, play the most important role for the normalisation of the globe's motility. Even late reconstructions of orbital wall fractures achieve good functional results. Only a fracture of the zygomatic bone healed in dislocation cannot be brought back to its proper anatomical position after a period of 4 to 5 weeks. Functionally it is, however, of minor importance. But there is an obvious connection between the type of the fracture and the extent as well as the regression of the motility disturbance of the globe. With isolated fractures of the zygomatic bone there are practically no motility restrictions, with combined fractures of the orbital entrance and the orbital floor there can but there need not be a motility disturbance. Severe motility disturbances are almost always caused by isolated blow out-fractures, especially with the trap-door mechanism and with fractures of the medial orbital wall. Even after an exact anatomical operative reconstruction motility disturbances in connection with medial orbital wall fractures remain for months, whereas they disappear 5 weeks after the operation at the latest with the other types of fractures.(ABSTRACT TRUNCATED AT 400 WORDS)