Diagnosis and clinical presentation, workup and decision-making of orbital fractures

Management of orbital fractures has been a topic of controversy for the last 50 years. There is consensus on acute indications for orbital reconstruction and the need for surgery in large fractures with severe functional symptoms or early enophthalmos. Small fractures without complaints will generally be treated without surgery. There is a large grey area between these more obvious cases with no clear consensus about the indication and timing of treatment. It is difficult to predict which of the symptoms (diplopia and limited motility) will resolve spontaneously, and no clear predictors for the development of enophthalmos exist. This chapter describes the relevance of clinical symptoms and considerations for conservative or surgical treatment, based on the latest scientific evidence. A well-designed and generally accepted clinical protocol for orbital fractures ensures a uniform treatment approach, cooperation between different specialities, and adequate outcome evaluation. This facilitates the clinical decision-making and optimisation of the treatment.