In the course of outpatient treatment, we often meet patients who come to our hospital with a CT report that says: “orbital XX wall fracture” or more seriously: “orbital XX wall comminuted fracture with fatty muscle canthole”. Patients often ask whether my fracture requires surgery. In this article, we answer four questions: Do orbital fractures require surgery? 4: What are the consequences of not having surgery? A: Is surgery necessary for orbital fractures A: No, it is not necessary. Not every case of orbital fracture requires surgery, because the lower wall of the orbit is the weakest of the four walls of the orbit and is prone to fracture when subjected to blunt external forces. However, if the fracture is large in extent, the eye will be sunken in the late stage and surgery is needed. The size of the fracture should be determined by reading the CT film. B: What are the indications for surgery A: Expert consensus on orbital fracture: indications for orbital fracture surgery include “(1) >2MM depression of the eye; (2) persistence of visual impairment diplopia without significant improvement; (3) positive passive pull test, CT shows that the extraocular muscles are embedded in the fracture, or the extraocular muscles and surrounding fat herniate significantly into the fracture area, or the extraocular muscles are distorted with abnormal morphology. abnormal shape. (4) Even if no significant sunken eye has occurred, CT shows that the orbital wall fracture exceeds 50% of the orbital wall area, or the fracture area is >2M2 or the bone wall is displaced by more than 3MM. iii: Will the surgery affect the appearance and is it risky? A: For a surgeon skilled in orbital surgery; fractures of the medial, lateral, and inferior orbital walls can be operated through a conjunctival approach, and after recovery, there is no surgical scar on the face, so it will not affect the appearance. Even with the eyelid skin approach, the surgical scar is basically invisible after three months because of the incision made in line with the skin line. All surgery carries risks, and a skilled orbital surgeon will minimize the risks of surgery. Vision is usually not affected, and we have even encountered many patients with orbital fractures with optic nerve contusions clinically who have improved vision after surgery, possibly related to post-operative orbital decompression. IV: What are the consequences of not having surgery? A: For some fractures of larger extent, due to the initial stage of injury, orbital hemorrhage and tissue swelling, the eye will not be depressed, or even protrude more prominently than the healthy eye after the injury, the doctor suggests the patient to operate, and the patient cannot understand it. In such patients, three months after the hematoma subsides and the fat atrophies or depresses into the fracture area, there will be obvious inversion of the eye, and due to the imbalance of both eyes, some patients will also have visual fatigue symptoms. At this time, the patient visits the clinic again and asks for surgery, at this time, due to tissue adhesions and fat entrapment, the surgery is very difficult, bleeding more time, and the surgical effect is also affected, which is equivalent to delaying the disease; for adolescents, 15 days after the injury, eye movement disorders and then surgery recovery is also poor. Therefore, it is generally recommended that surgery is better 7-14 days after the injury.