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Impact of surgical timing of postoperative ocular motility in orbital blowout fractures
  1. Yukito Yamanaka1,
  2. Akihide Watanabe1,
  3. Chie Sotozono1,
  4. Shigeru Kinoshita2
  1. 1 Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, Kyoto, Japan
  2. 2 Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
  1. Correspondence to Dr Akihide Watanabe, Department of Ophthalmology, Kyoto Prefectural University of Medicine, Graduate School of Medicine, 465 Kajii cho, Hirokoji agaru, Kawaramachi dori, Kamigyo ku, Kyoto 602 0841, Japan; awatanab{at}


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

Methods 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.

Results 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).

Conclusions 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.

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

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  • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work and take personal responsibility for the content, including participation in the concept, design, analysis, writing and/or revision of the manuscript. Furthermore, each author certifies that this material, or similar material, has not been, and will not be, submitted to or published in any other publication before its appearance in the British Journal of Ophthalmology. Conception and design of study: YY and AW. Acquisition of data: YY and AW. Analysis and/or interpretation of data: YY and AW. Drafting of the manuscript: AW, CS and SK. Critical revision of the manuscript for important intellectual content: AW, CS and SK. Approval of the version of the manuscript to be published: YY, AW, CS and SK.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board of Kyoto Prefectural University of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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