Comparison of clinicoradiological findings between patients with recovering diplopia and those with residual diplopia after surgery for pure orbital blowout fracture

Abstract Purpose Diplopia is a common symptom of blowout fracture (BOF), and can persist after proper surgical management. We compared clinicoradiological findings between patients with recovering diplopia and those with residual diplopia after surgery for orbital BOF. Materials and methods We retrospectively evaluated the CT images of 170 patients with orbital BOF and preoperative diplopia. We reviewed the following factors: sex, age, mechanism of injury, presence of diplopia before surgery, presence of enophthalmos before surgery, presence of an ocular motility abnormality before surgery, time interval between the trauma and surgery, fracture type, fracture size, volume of herniated orbital soft tissue, ratio of the volume of herniated orbital soft tissue to fracture size, number of points of contact between the extraocular muscle (EOM) and bony edge, EOM swelling, EOM swelling ratio, EOM displacement, EOM circling, EOM tenting, and EOM entrapment. The associations between the presence of diplopia 6 months after surgical repair and various clinicoradiological findings were analyzed using Wilcoxon rank-sum tests, Student's t -tests, Fisher's exact tests for univariable analysis, and logistic regression analysis for multivariable analysis. A Kaplan–Meier curve and log-rank test were used to identify the recovery status from diplopia. Results The following findings were significantly different between patients with recovering diplopia and those with residual diplopia on univariable analysis ( p p- values: 0.006, 0.013, and p  = 0.02). Additionally, young patients (0–12 years) showed a shorter recovery time from diplopia compared with older patients (>24 years) ( p Conclusion Patients with residual diplopia after surgical management have different clinicoradiological findings compared with patients with recovering diplopia. Patients who are older, or those who have circling or tenting of the EOM on CT scans, are more likely to have residual diplopia.