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Br J Ophthalmol. 2018 Mar;102(3):398-403. doi: 10.1136/bjophthalmol-2017-310312. Epub 2017 Jul 25.

Impact of surgical timing of postoperative ocular motility in orbital blowout fractures.

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Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan.
Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.



To investigate the surgical timing postinjury in regard to ocular motility in patients with orbital-floor blowout fractures.


This study involved 197 eyes (92 right eyes and 105 left eyes) of 197 patients (154 males and 43 females, mean age: 29.0 years, range: 7-85 years) with pure orbital blowout fractures. All patients underwent surgical repair within 30 days postinjury and were followed up for 3 months or more postoperative (mean follow-up period: 8.4 months, range: 3-59 months). Orbital blowout fractures were classified into one of three shapes: (1) trap-door fracture with muscle entrapment, (2) trap-door fracture with incarcerated tissue and (3) depressed fragment fracture. Ocular motility was estimated by percentage of Hess area ratio (HAR%) on the Hess chart at the final follow-up examination. In addition, correlations between postinjury surgical timing and HAR% were analysed.


The mean postinjury surgical timing was 10.7±7.8 days (range: 0-30 days). The mean postoperative HAR% (92.9%±10.5%) was significantly improved compared with preoperative HAR% (73.5%±21.7%) (p<0.01). The mean postoperative HAR% (98.3%±4.4%) of the orbital-floor trap-door fracture patients with incarcerated tissue who underwent surgical repair within 8 days postinjury was significantly better than that of the patients who underwent surgical repair after 8 days (94.2%±5.8%) (p<0.01).


Patients with orbital-floor trap-door blowout fractures with incarcerated tissue that were repaired within 8 days postinjury had better outcomes than those repaired after 8 days, and HAR% is a useful method to record orbital fracture surgical outcomes.


orbital blowout fracture; percentage of hess area ratio (HAR%); surgical timing

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