Objective : Prospectively analyze the evolution of extrinsic eye movements and diplopia from both clinical and radiological perspectives in patients with orbital wall fractures (blow-out) identifying significant prognostic factors for long-term posttraumatic diplopia.

Methods : This is a prospective study of 18 patients presenting either isolated fractures of the orbital walls or associated with simple fractures involving the orbital rims, surgically treated either by “functional” indication (impairment in extrinsic ocular motility and/or diplopia associated with orbital fracture with possible incarceration) or “aesthetic” (restitution of previous orbital anatomy and volume with a significant difference with the contralateral side to prevent posttraumatic enophthalmos). 0.6 mm cut CT-scan were performed to all the patients on the day of admission and also postoperatively as well as a complete ophthalmological examination.

Conclusions : All patients with persistent posttraumatic diplopia (both at 12 and 24 weeks) presented at least one altered rectus muscle anatomy in preoperative CT scan (abnormal shape and sometimes pinching) that persisted in the early postoperative CT scan. All patients presenting persistent diplopia 12 weeks after surgery presented anatomical rectus muscle alteration (including elongation/abnormal shape/impingement) at preoperative CT and bad prognosis in relation to diplopia, persisting at 24 weeks control in all of them.