Evolving concepts in the management of orbital fractures with enophthalmos: A retrospective comparative analysis

Background/introduction: Enophthalmos, a common sequela following orbital trauma, may not be immediately evident, and it is often diagnosed late or inadequately treated. Managing orbital fractures with enophthalmos can be challenging and unpredictable. Purpose(s)/aim(s): This study evaluated the long-term enophthalmos outcome following surgical correction for different types of orbital fractures at various time intervals. Methods: Medical charts of 304 patients with orbital fractures were retrospectively reviewed. Several factors, including surgical timing, fracture zones, and orbital wall fractures, were analyzed. The improvement rate of enophthalmos following corrective surgery was compared with respect to the type of orbital wall fracture and surgical timing. Orbital wall fractures were classified into three types according to the number of walls involved: single-wall fracture (Type I orbital wall fracture), two-wall fracture (Type II orbital wall fracture), and three-to-four-wall fracture (Type III orbital wall fracture). Results: The most common pattern of facial injury is facial fracture involving the bony orbit and adjacent facial bones (Zone II). The overall incidence of enophthalmos in the present study was 56.9%. The incidence of residual enophthalmos following corrective surgery was 11.8% in Type I, 27.4% in Type II, and 16.4% in Type III orbital wall fractures (p ≤ 0.001). The improvement rates for enophthalmos at various time intervals, <2 weeks, within 2-4 weeks, and >4 weeks, were 65.6%, 80%, and 76.2%, respectively; however, a significant difference was not observed (p = 0.194). Conclusion: Orbital fractures with enophthalmos can be corrected at various time intervals with a comparable improvement rate. Surgical indications and surgery timing for orbital fractures with enophthalmos should be individualized on the basis of the severity of injury and type of orbital wall fracture.