Another look at blow-out fractures of the orbit.

Thirty cases of orbital floor blow-out fractures proven by tomography were retrospectively reviewed to determine the accuracy of the plain films. Using the maximum diameter from the tomograms, the area and volume of the fractures were calculated and correlated with the presence of diplopia and enophthalmos at the time of presentation and at subsequent follow-up. Nine of the 30 cases underwent surgical repair. Orbital floor fractures were recognized in 29 of 30 cases using only the 28 degrees Caldwell and Waters views. Routine tomography is unnecessary and should be reserved as a preoperative evaluation in patients with enophthalmos to establish the presence of a significant associated medial wall prolapse.