Correlation Between Ocular Motility and Evaluation of Computed Tomography in Orbital Blowout Fracture

Purpose: To investigate outcomes of management of blowout fracture patients evaluating computed tomography (CT) findings and diplopia.

Design: Single-center retrospective interventional consecutive case series.

Methods: This study included 113 cases of pure blowout orbital fracture with diplopia. We investigated patients' satisfaction based on percentage of Hess area ratio (HAR%) on the Hess chart, evaluating fracture type and number of points of contact of extraocular muscles to the fracture edge (points of muscle contact) based on CT.

Results: Of the patients with HAR% > 85%, most experienced no diplopia. Sixty-two (55%) of 113 patients underwent surgical repair to improve diplopia, and 31 (50%) of 62 patients had surgery within three days after injury. A favorable outcome with HAR% > 85% was seen in 81 (72%) of 113 patients. Of 32 patients with two points of muscle contact at one extraocular muscle, 15 patients (47%) improved with a final HAR% > 85%. None of the four patients with medial wall fracture and two points of muscle contact had improved in their final HAR% > 85%. Thirty (97%) of 31 patients with either floor or medial wall fracture and no muscle involvement had a favorable outcome regardless of fracture type. Initial CT findings of the rectus muscle was strongly correlated with a mean initial HAR% (r = -0.94) and a mean final HAR% (r = -0.87).

Conclusions: The clinical manifestations and prognosis of patients were approximately predicted through the analysis of CT on fracture type and number of points of contact of an extraocular muscle to the fracture edge.