Evidence-Based Decision Making in Orbital Fractures: Implementation of a Clinical Protocol.

In 1957, Smith and Reagan1 described the mechanism of internal orbit correction after a blow-out fracture. The investigators advocated early intervention by exploration and reconstruction of the orbital defect. Ten years later, Converse and colleagues2 published a 10-year survey on orbital fractures and recommended a more conservative approach. In the 1970s, Putterman, an ophthalmologist, identified contusion and edema of the extraocular muscles as the main cause of diplopia and advocated a nonsurgical approach to prevent surgical-related problems, such as scarring and atrophy.