Diplopia of Pediatric Orbital Blowout Fractures: A Retrospective Study of 83 Patients Classified by Age Groups

Orbital blowout fractures are relatively rare in patients under 18 years of age, but may lead to serious complications. We conducted this retrospective study to evaluate diplopia, clinical characteristics, and postoperative results in cases of orbital blowout fractures in the pediatric population. Eighty-three patients, all less than 18 years old, with orbital blowout fractures, were divided into 3 groups by age: 0 to 6 years old, 7 to 12 years old, and 13 to 18 years old. The cause of injury, fracture locations, diplopia grades, ocular motility restrictions, enophthalmos, and postoperative results were reviewed from their records. Chi-square tests, Fisher's exact analyses, analyses of variance, and logistic regressions were performed to determine characteristics associated with diplopia, and to identify factors related to residual diplopia in pediatric patients. The most common causes of injuries were traffic accidents in the 0 to 6 years old group, normal daily activities in the 7 to 12 years old group, and assaults in the 13 to 18 years old group. Floor fractures were the most common location in both the 0 to 6- and 7 to 12 years old groups, and medial-floor fractures were the most common location in the 13 to 18 years old group. The occurrence of preoperative diplopia was related to ocular motility restriction and enophthalmos, but not with the age group, the gender, the cause of injury, or the fracture locations. The time interval from injury to surgery was significant in the outcome of postoperative diplopia (P < 0.01). A statistical difference was also found in the recovery time from diplopia among the 3 age groups (P < 0.01). The characteristics of orbital blowout fracture varied among the different age groups. It was related to 2 factors, the cause of injury and fracture locations, which probably resulted from structural growth changes and differences in daily habits. Children had a slower recovery from orbital fractures, and the younger the patient, the longer it took for recovery from diplopia after surgery.