The Impact of Surgical Timing in Orbital Fracture Repair: A New Paradigm

Background: For decades, there has been an ongoing debate about the ideal timing of orbital fracture repair (OFR) in adults. Methods: The authors conducted a retrospective review of patients who underwent OFR at 2 centers (2015 to 2019). Excluded were patients younger than 18 years and those with follow-up less than 2 weeks. The study's primary outcome was the incidence/persistence of postoperative enophthalmos/diplopia at least 2 weeks following OFR. The association between surgical timing and postoperative ocular complications was assessed in patients with extraocular muscle (EOM) entrapment, enophthalmos and/or diplopia, and different fracture sizes. Results: Of 253 patients, 13 (5.1%) had preoperative EOM entrapment. Of these, patients who had OFR within 2 days of injury were less likely to develop postoperative diplopia compared with patients who had OFR within 8 to 14 days (1 of 8 patients [12.5%] versus 3 of 3 patients [100%]; P = 0.018). Patients who had OFR for nearly total defects within 1 week of injury were significantly less likely to have postoperative enophthalmos (0 patients [0.0%]) compared with those who had surgery after 2 weeks (2 patients [33.3%] after 15 to 28 days versus 8 patients [34.8%] after 28 days from injury; P < 0.001). Patients who had delayed OFR for large fractures smaller than nearly total defects, preoperative persistent diplopia, or enophthalmos were not at significantly greater likelihood of postoperative ocular complications compared with those who had early OFR. Conclusions: The authors recommend OFR within 2 days of injury for EOM entrapment and 1 week for nearly total defects. Surgical delay up to at least 4 weeks is possible in case of less severe fractures, preoperative persistent diplopia, or enophthalmos.