When is surgical therapy indicated for a patient with a blowout (orbital) fracture?

Surgical therapy for a blowout (orbital) fracture is indicated primarily in circumstances where there is significant functional impairment or anatomical compromise. In the context of this question, the presence of muscle entrapment, significant enophthalmos, or oculocardiac reflex represents urgent situations that necessitate surgical intervention.

Muscle entrapment can lead to restricted eye movement and potential long-term complications if not addressed. Significant enophthalmos, which is the posterior displacement of the eyeball within the orbit, can affect both appearance and function. The oculocardiac reflex, a phenomenon where pressure on the eyeball causes bradycardia and other cardiovascular responses, can be life-threatening and warrants immediate attention.

In contrast, conditions such as subtle enophthalmos and mild strabismus, controlled intraocular pressure, or minor vision changes do not typically require surgical intervention, as they may not significantly impact the patient's visual function or the structural integrity of the eye. Management of these situations is often conservative, focusing on observation and monitoring rather than immediate surgery.