THE ROLE OF PLAIN RADIOGRAPHY IN THE MANAGEMENT OF SUSPECTED ORBITAL BLOW-OUT FRACTURES

We reviewed the indications for radiography and its impact on manageme nt in 100 consecutive patients referred to the Radiology Department fr om the Accident and Emergency Department of a large eye hospital in or der to assess the utility of orbital plain radiographs in patients sus pected of having blow-out fractures. We assessed whether administratio n of antibiotics or referral for surgical or orthoptic treatment was i nfluenced by clinical features, radiographic findings or both. Ophthal mologists interpreting the radiographs appeared to be guided by the pr esence or absence of physical signs. No patient in whom they overlooke d a fracture which was not evident clinically was subsequently referre d for surgery. All patients who did have surgery for complications of a blow-out fracture underwent pre-operative computed tomography. Neith er referral for orthoptic treatment nor administration of systemic ant ibiotics was consistently influenced by the presence or absence of a f racture. Given these findings, and the observation that the decision t o operate was guided exclusively by clinical rather than radiological criteria, we recommend that only patients with well-defined indication s for surgery (enophthalmos of more than 2 mm at any time within the f irst 6 weeks following the injury, and/or diplopia in the primary and/ or downgaze reading positions not showing evidence of resolving within 2 weeks of the injury) should undergo radiography.