Management of Diplopia Associated with Blowout Fracture

While the majority of blowout fractures result in favorable outcomes regardless of treatment, few cases of poor outcome inevitably occur, and treatment for these cases remains an important issue. In the present study, we describe the pathology of blowout fractures and the treatment for cases of diplopia, based on our own 250 patients and recent literature.Clinical conditions that result from blowout fractures and are involved in the onset mechanism of diplopia primarily include herniation of soft tissue, swelling caused by bleeding or infiltration of exudates, and extraocular muscle damage. Extraocular muscle damage includes mechanical damage resulting from impaction at the fracture site, as well as varying degrees of damage to the muscle itself.Factors related to the prognosis of diplopia include children, constriction of extraocular muscle, and severe diplopia, and these factors are often mutually related. In addition, early surgery is indicated for patients to whom these factors apply. Although indication for surgery is determined on an elective basis for other patients, certain clinical conditions can be expected to be resolved by waiting, as follows: swelling of soft tissue around extraocular muscles resolves at around 2 weeks, mild damage (such as concussion and contusion) to extraocular muscle resolves at 1-2 months, and severe damage (fibrosis due to Volkmann contracture) to extraocular muscle resolves at around 6 months to over a year. The treatment of blowout fractures requires accurate determination of the clinical conditions of each patient and treatment should be selected accordingly.