Severe ocular injuries are uncommon in patients with pure orbital blow-out fractures. Over a 3-year period, 45 patients with radiologically proved blow-out fractures were reviewed by an ophthalmologist. Decrease in visual acuity was the main clinical finding accompanying significant eye injury. Although most eye injuries were transient, early ophthalmic assessment is recommended to exclude potentially serious complications such as traumatic optic neuropathy. Troublesome diplopia may delay rapid rehabilitation.