To evaluate the predictive factors of diplopia and extraocular movement (EOM) limitations in the patients with isolated pure blow-out fracture.

In a prospective interventional case series, 132 patients with isolated pure blow-out fracture were included. Logistic regression models were used to model diplopia and EOM limitation as a function of age, gender, type of trauma, type of fracture, enophthalmos>2mm, infraorbital hypoesthesia, time interval from trauma to the first visit, and time interval from trauma to the surgery. Receiver operating characteristic (ROC) curve analysis was used in the surgical group to evaluate the power of time interval from trauma to the surgery to predict 6 months postoperative diplopia and EOM limitation.

After 6 months follow-up, 8 of 132 patients had persistent diplopia and EOM limitations. Type of fracture was significantly associated with first visit diplopia and EOM limitations. In the surgical group, type of fracture and time interval from trauma to the surgery were significantly associated with 1 month diplopia and EOM limitations. Only time interval from trauma to the surgery was significantly associated with 3 months EOM limitation. In the ROC curve analysis, the best cut-off points were 4.5 days for diplopia and 7.5 days for EOM limitations.

In the early postoperative period, higher rate of diplopia was expected in the patients with inferomedial wall fractures or with longer time intervals from trauma to the surgery. The best time for blow-out fracture surgery was within 4.5 days after the trauma.