Surgical Timing of the Orbital “Blowout” Fracture: A Systematic Review and Meta-analysis

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The orbital blowout fracture is a common facial injury, carrying with it a risk of visual impairment and undesirable cosmetic results unless treated properly. Optimal timing of the surgical treatment is still a matter of debate. We set out to determine whether a meta-analysis would bring us closer to an answer to this question.

Data Sources

PubMed, EMBASE, Web of Science, and the Cochrane Library were searched from January 1980 to August 2014. We applied the following inclusion criteria: isolated blowout fractures, presenting early and late surgery groups (<14 and >14 days). Patients were evaluated for diplopia and enophthalmos.

Review Methods

We followed the statements of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Pooled odds ratios were estimated with the fixed effects method of Mantel-Haenszel.


We identified 5 studies with available outcome data (N = 442). Patients in the late group showed an odds ratio of 3.3 (P = .027) for persistent postoperative diplopia as compared with the early group. We found no significant difference between the groups when assessing postoperative enophthalmos as an isolated symptom.


We found a significantly increased risk of persistent diplopia in patients who were operated >14 days after the trauma.

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