BackgroundThis study aimed to describe and compare eyelid contours before and after orbital fat decompression in patients with Graves’ ophthalmopathy (GO) by measuring their midpupil lid distances (MPLDs).MethodsA retrospective comparative study of patients with GO who underwent orbital fat decompression was performed. Standard digital images of primary gaze were analyzed using a self-designed software. Radial MPLDs of the upper and lower eyelids were measured from 0° (nasal) to 180° (temporal) with 15° spacing. Pre- and postoperative MPLDs were compared and the relationship between MPLD changes and Hertel exophthalmometric value changes were analyzed. Eyelid contour symmetries were assessed using the nasal-to-temporal MPLD ratios.ResultsA total of 31 eyes from 17 patients and 25 eyes from 17 normal participants (control) were included. The mean postoperative Hertel value change was 3.8 ± 1.1 mm. After orbital fat decompression, MPLDs in the lower eyelids decreased, more significantly on the nasal sectors (nasal 30°, 45°, 60°, 75°, and 90°, p = 0.030, 0.024, 0.036, 0.040, and 0.042, respectively). Conversely, MPLDs slightly increased in the upper eyelids but was not statistically significant. Changes in MPLDs did not correlate with the extent of proptosis reduction.ConclusionsOrbital fat decompression effectively improves lower eyelid retraction in patients with GO, especially on the nasal sectors. This effect is independent from the amount of proptosis reduction. Upper eyelid contour remains unchanged after the surgery.

ObjectiveTo report the efficacy of “Xeno-ADM combined with inferior eyelid margin fixation” for entropion accompanied by lower eyelid retraction.MethodsA retrospective review of 28 patients (48 eyes) diagnosed with lower eyelid entropion accompanied by lower eyelid retraction was performed. The follow-up period lasted more than 6 months. MRD2, angle between the eyelashes and the corneal surface, ocular discomfort symptoms, and complications were recorded and used to evaluate the efficacy and safety.ResultsTwenty eight patients (48 eyes) were included, within 6 months after surgery, 45 eyes (93.75%) had complete relief from ocular discomfort, while 3 eyes (6.3%) showed partial improvement; 48 eyes (100%) had complete resolution of the foreign body sensation; 15 eyes (83.3%) had complete relief from lacrimation, and 3 eyes (16.7%) showed partial improvement, MRD2 was from 7.2 (7.0, 7.5) mm to 5.5 (5.0, 5.5) mm (Z = -3.995, P < 0.01). The angle between the eyelashes and the cornea was from 36.76 (32.18, 38.49) to 68.23 (67.30, 70.31) (Z = -6.031, P < 0.01). And no other complications, such as infection, rejection, and dislocation, were observed.ConclusionXeno-ADM combined with inferior eyelid margin fixation is reasonably successful in managing entropion accompanied by lower eyelid retraction.

Lower eyelid retraction (LER) affects both aesthetics and eye function, often resulting from surgery, Graves' orbitopathy, or aging. Various grafting techniques are employed in its correction. This study aimed to compare the efficacy of autologous dermis and auricular cartilage grafts in treating LER, with primary focus on changes in margin reflex distance 2 (MRD2). This prospective, randomized interventional study included 26 patients with stable LER. Patients were randomly assigned to receive either auricular cartilage or dermis grafts in surgical correction, using a 2-mm graft: 1mm scleral show ratio. MRD2 measurements were taken preoperatively and at several postoperative intervals, with complications and outcomes recorded. The study included 35 eyelids from 20 patients, split evenly between the two graft groups. A significant improvement in MRD2 was observed in both groups post-surgery. Group 1 (cartilage) showed a 10% MRD2 increase over six months, while Group 2 (dermis) showed an 18% increment. Complication rates were low, with seven eyelids in the cartilage group developing granulomas. No persistent keratopathy or infection was noted. Dermis grafts exhibited no cysts or contour issues. Both graft types were effective for LER treatment, with dermis grafts showing fewer complications and quicker recovery. Recommendations for graft height adjustment may enhance outcomes, particularly in severe cases. Additional techniques like midface elevation could improve results. Further research with a larger sample size is warranted to confirm these findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ABSTRACT Introduction Inferior rectus (IR) recession surgery is commonly performed for vertical strabismus, yet overcorrection risk remains high (21–50%) due to factors like lower lid retractors, suture dissolution, and muscle tension in thyroid eye disease (TED). This study aims to contribute novel insights by comparing clinical outcomes of IR recession using absorbable and non-absorbable sutures. Methods A retrospective study (01/12/20–31/01/23) was conducted at a tertiary referral center on patients undergoing IR recession with absorbable or non-absorbable sutures. The following data were collected: absorbable vs non-absorbable suture use, age at operation, sex, date of operation, surgical indication, presence of TED, adjustable vs non-adjustable suture technique, surgeon training level, number of muscles recessed, IR distance recessed, and time from surgery to final follow-up. Results Thirty-two IR recession procedures were evaluated (26 absorbable, 6 non-absorbable cases) with a mean follow-up of 3.6 months. Both groups achieved similar success in vertical deviation control with no significant difference in success rates for distance (p = .48) or near fixation (p = .21). Overcorrection occurred in 23.1% (absorbable) and 16.7% (non-absorbable) cases, with no statistical difference (p = .61). Logistic regression analysis was performed, which showed that TED (p = .99), surgeon training level (p = .20), adjustable sutures (p = .89) and number of muscles operated on (p = .28) did not significantly impact success for absorbable sutures. Conclusion This study demonstrates that IR recession surgeries using absorbable sutures yield outcomes comparable to those using non-absorbable sutures, with no significant difference in success rates and overcorrection rates consistent with existing literature. These findings suggest that absorbable sutures are equally viable in use for IR recession surgeries.

This study aims to construct a semantic segmentation-based auxiliary diagnostic model for thyroid eye disease (TED) focusing on eyelid retraction, eye movement disorders, ocular inflammation related to Clinical Activity Score (CAS), facilitating rapid and non-invasive diagnosis for suspected TED patients and enhancing the efficiency of treatment and diagnosis. Data were collected from 153 subjects exhibiting symptoms of eyelid retraction, eye movement disorders, and ocular inflammation related to CAS. After quality screening, datasets for the primary position (303 eyes), gaze positions (1,199 eyes), and a multi-label inflammatory classification dataset (272 eyes) were constructed. The constructed TBRM-Net adopts a dual-branch feature extraction and fusion strategy to extract inflammation features for multi-label classification and recognition; the constructed DSR-Net performs segmentation of ocular structures and has designed a quantitative diagnostic algorithm. The semantic segmentation-based auxiliary diagnostic model for TED demonstrated a mean pixel accuracy (MPA) of 94.1% in the primary position dataset and 95.0% in the gaze positions dataset. The accuracy for diagnosing eye movement disorders, upper eyelid retraction, and lower eyelid retraction reached 85.4%, 95.1%, and 87.0%, respectively. The accuracy for Redness of Eyelids, Swelling of Eyelids, Redness of Conjunctiva, Swelling of Conjunctiva, and Swelling of Caruncle or Plica reaches 81.8%, 78.8%, 90.6%, 73.5%, and 83.9%, respectively, with an average accuracy of 81.7%. Segmenting and classifying images of structures affected by ocular inflammation can effectively exclude interfering features. The designed quantitative algorithm provides greater interpretability than existing studies, thereby validating the effectiveness of the diagnostic system. The deep learning-based auxiliary diagnostic model for TED established in this study exhibits high accuracy and interpretability in the diagnosis of ocular inflammation related to CAS, eyelid retraction, and eye movement disorders. It holds significant medical value in assisting doctors in formulating treatment plans and evaluating therapeutic effects.

Introduction: Unsatisfied patients are inevitable in the field of cosmetic surgery. There is limited literature regarding management of the unsatisfied patient, with even less discussion on the role of refunds. The purpose of this study is to present cosmetic surgery refund data from a multi-center oculofacial plastic surgery practice and review the literature regarding strategies to alleviate post-operative patient concerns. Materials and Methods: A retrospective chart review was conducted on patients who received cosmetic surgery refunds for pure aesthetic upper and lower blepharoplasty, brow lifts, ptosis repairs, fat grafting, and facelifts from July 2016 to December 2023 in our oculofacial plastic surgery private practice. Financial data, reasons for refund, demographics, and medical history were collected. Results: Eight patients (1 male, 7 female) with a mean age of 60.5 ± 16.1 years received cosmetic surgery–associated refunds during the study period. Reasons for patient dissatisfaction were perception of residual upper eyelid skin, lateral canthal web, prolonged malar edema, lower eyelid retraction, asymmetric palpebral fissure on downgaze, and temporal brow lift scarring. Dissatisfaction with respective procedures led to refunds in 4 of 1909 upper blepharoplasties (0.21%), 3 of 1704 lower blepharoplasties (0.18%), and 1 of 427 brow lifts (0.23%). Unsatisfied patients had a mean of 6 post-op visits. Refunds occurred in 0.23% of aesthetic surgical patients and represented 0.41% of the total cosmetic surgery income. Conclusions: Although willingness to provide refunds varies, when combined with pre-operative patient selection and expectation management, issuance of refunds may be an additional tool to help alleviate post-operative aesthetic patient concerns and minimize negative reviews and lawsuits.

The involvement of extraocular muscles (EOMs) in the inflammatory process in thyroid eye disease (TED) often leads to fibrosis, persistent restrictive strabismus, and binocular diplopia. The inferior rectus muscle (IRM) is most commonly affected, resulting in vertical strabismus and hypotropia with significant limitation of upward gaze. Surgical management of restrictive strabismus in TED aims to increase the range of binocular eye movements, eliminate binocular diplopia, and correct the cosmetic defect associated with strabismus. The "gold standard" surgery involves weakening of the affected muscles, and is called muscle recession. In cases of severe fibrotic changes, maximal surgical intervention - so-called deep recession - is needed. Due to the anatomical characteristics of the capsulopalpebral fascia (CPF), the main component of the lower eyelid retractors, which originates from the inferior part of the IRM belly, deep IRM recession results in lower eyelid retraction. This significantly affects both the functional state of the lower eyelid (leading to lagophthalmos) and the symmetry of the palpebral fissures. Moderate lower eyelid retraction is typically managed with retractor dissection and lateral canthoplasty, whereas in severe cases various spacers are used. To minimize the number of surgical stages, techniques have been proposed for repositioning and dissecting the Lockwood ligament, specifically the CPF head, simultaneously with IRM recession. However, the effectiveness of these methods remains debatable, and the risk of intraoperative complications is high. Further research is needed to develop an optimal surgical approach for TED patients.

Lower eyelid festoons are a challenging aesthetic concern characterized by redundant and edematous folds of lower eyelid skin with minimal orbital fat prolapse. The authors present their surgical approach to managing this condition. A retrospective chart review was conducted on patients who underwent surgical repair of lower eyelid festoons at 2 academic centers. Data collected included various measurements, examinations, and satisfaction rates. The procedure involved lower eyelid tightening, an infraorbital curvilinear incision along the base of the lowest festoon, subcutaneous dissection, skin redraping, and closure with a running 7-0 Prolene suture. The orbital septum was kept intact with no orbital fat manipulation. Fifty-four eyes of 27 patients (mean patient age, 69 ± 10 years) were studied, with a mean follow-up of 11 months. The average vertical extent of excised skin was 15 mm. No patient developed lagophthalmos, corneal staining, or eyelid retraction. Minor complications occurred in 2 patients. The recurrence rate was 3.7%. The patient and physician satisfaction rates were high. Direct infraorbital excision of festoons with concomitant preservation of the inferior tarsal orbicularis oculi muscle, lower eyelid tightening, and septal preservation is a simple and effective treatment option. More than 10 mm of skin can be excised safely without causing lower eyelid retraction. Outcomes are durable at a mean follow-up of nearly 1 year. Therapeutic, IV.

Epiblepharon is a congenital anatopism characterized by a horizontal skinfold near the eyelid margin, causing corneal irritation and damage. Standard surgical management occasionally results in undercorrection and relatively high recurrence. In addition, a pronounced postoperative lower eyelid crease can be an unfavorable cosmetic alteration, particularly for Asian patients. This work describes a new surgical technique to reduce recurrence rates while improving cosmetic and functional outcomes for epiblepharon. Thirty-nine patients (75 eyelids) underwent epiblepharon surgery from January 2021 to April 2023. Their mean age was 15.0 years with a mean follow-up period of 16.5 months. Surgically, the lower eyelid retractors (LERs) were fully exposed and detached from the inferior tarsus margin and conjunctiva. The free LERs were sutured directly to the marginal orbicularis oculi muscle, maintaining flexible mobility to the LERs without standard anchoring to the tarsus margin. All 39 patients achieved complete eversion of the cilia without cornea contact by the final follow-up. Of the 75 eyelids, 70 (93%) demonstrated a "good" outcome, 5 (7%) had a "fair" outcome, and none were classified as "poor." Mean margin-to-reflex distance 2 remained statistically unchanged between preoperative and postoperative measurements. Our new surgical method provides satisfactory functional and cosmetic results, reducing recurrence rates and minimizing the risk of excessive lower eyelid crease, ectropion, and severe hypertrophic scarring. The method offers a reliable alternative, particularly for Asian patients, who typically have less pronounced eyelid creases.

IntroductionRheumatoid nodules are one of the most common extra-articular manifestations in rheumatoid arthritis (RA) being extremely uncommon in the ocular and periocular area. To the authors' knowledge, this is the second case of an orbital rheumatoid nodule.Case descriptionA 44-year-old woman with RA presented with a painful hard mass in the inferolateral right orbital rim causing mild lower lid retraction, ptosis and exophthalmos. Magnetic Resonance Imaging showed a extraconal mass involving the lower eyelid and fat tissue of the infratemporal fossa. An incisional biopsy demonstrated an orbital rheumatoid nodule.ConclusionsRheumatoid nodule's should be considered as a differential diagnosis for an orbital tumour found in patients with RA.

To investigate the clinical efficacy of a method that corrects tear trough deformity by subcutaneous fixation of orbital septal fat flaps using syringe-guided absorbable barbed sutures. A retrospective analysis was conducted on the clinical data of 125 cases with lower eyelid bags accompanied by tear trough deformity who were treated in the Department of Plastic Surgery at Zhengzhou People's Hospital from 2020 to 2024. Among them, there were 13 males and 112 females, with an average age of 34.2 ± 6.8 years. A 1 to 1.5cm horizontal transconjunctival incision was made to release the orbital septal fat, forming a pedicled fat flap. The premaxillary space and part of the prezygomatic space were dissected. A syringe needle was bent and vertically inserted through the deepest point of the tear trough depression into the dissected space. One to 2 absorbable barbed sutures were passed through the central part of the fat flap. The tail end of the suture was inserted into the bent needle. The needle was retracted subcutaneously (the needle remained subcutaneous throughout), exited through another tunnel, and then a knot was tied to fix the fat flap at a position satisfactory to both the surgeon and the patient. The Tear Trough Rating Scale scores were assessed preoperatively and at 6 months postoperatively. The Tear Trough Rating Scale scores at 6 months postoperatively were significantly lower than those preoperatively ( P < 0.05), indicating a marked improvement in tear trough deformity. No complications, such as lower eyelid retraction, ectropion, or hematoma, occurred in any patient. The method of subcutaneous fixation of orbital septal fat flaps using syringe-guided barbed sutures effectively improves tear trough deformity and midfacial depression.

Lower eyelid lengthening is essential to correct eyelid retraction and preserve ocular surface integrity. We evaluated the efficacy of a novel percutaneous surgical technique that utilizes a silicone sheet to elongate the lower eyelids to minimize ocular surface inflammation and corneal damage. This case series included 15 patients (22 eyelids) with lower eyelid retraction who underwent a novel silicone-sheet-based lower eyelid elongation surgery by the same surgeon and completed at least 3 months of follow-up that involved consistent methods (ie, slit-lamp examination) between November 2014 and November 2023. Corneal epithelial damage and changes in the margin reflex distance-2 were measured preoperatively and postoperatively. Ocular surface discharge and foreign body sensation were assessed in patient interviews within the first postoperative week. During a mean postoperative follow-up of 31.9 months, the mean margin reflex distance-2 decreased from 7.17 to 5.89 mm. No recurrence or complications were observed. In all cases, superficial punctate keratopathy diminished within the first postoperative week and resolved within 1 month. Ocular discharge and foreign body sensation significantly decreased within a few days after surgery. A novel surgical technique using silicone-sheet spacers for lower eyelid elongation showed promising results in reducing ocular surface damage and improving patient outcomes. Despite its potential benefits over traditional methods, further large-scale, multicenter studies, including clinical trials, with diverse study populations are needed to generate robust data to validate and expand the applicability of this technique for managing lower eyelid retraction, particularly when involving eyelash contact with the ocular surface.

BackgroundTo report the presenting clinical, serological and treatment profiles of 1439 patients with thyroid eye disease (TED) from a tertiary centre in Hong Kong.Study populationsConsecutive patients with TED presented to...

To investigate the prevalence and types of eyelid disorders among an elderly population in China, underscoring the significance of eyelid health for the aging demographic. A cross-sectional epidemiological survey was conducted on 3038 individuals over the age of 50, all of whom were evaluated at the community health center. Each participant underwent routine ophthalmic examinations and eyelid morphology evaluations by an ophthalmologist. Eyelid disorders and morphology were assessed through slit-lamp examination and direct visual inspection. The study analyzed the characteristics of common eyelid disorders, including blepharoptosis, dermatochalasis, eyelid tumors, entropion, lower eyelid retraction (LER) and ectropion, as well as eyelid morphologies such as sunken and bulging eyelids. Descriptive statistics were used for demographic data, Chi-square test analyzed gender distribution differences, and logistic regression calculated odds ratios for blepharoptosis (P<0.05 considered significant). The study revealed that eyelid disorders were present in 1250 (41%) individuals, with blepharoptosis being the most common disorder (25%), followed by severe dermatochalasis (16%), eyelid tumors (9.3%), LER and ectropion (11%), and entropion (1.2%). Sunken eyelids were more prevalent in men (26%) than in women (17%). The study found significant associations between the presence of blepharoptosis and sunken upper eyelids [P=0.01, odds ratio (OR)=1.33], as well as male gender (P=0.038, OR=1.22). Additionally, the prevalence of blepharoptosis increased with age. Eyelid disorders are highly prevalent in older people and increase steeply with age. This study highlights the need for increased awareness of eyelid health among older individuals at risk for eyelid disorders and the importance of ophthalmic examination for early diagnosis and management of these disorders.

We present a case of repair of posttraumatic lower eyelid retraction with tissue loss and scarring after blunt trauma of the eye with a fracture of the inferior orbital wall. Attempted reconstruction of zygomatico-orbital region with titanium meshwork resulted in rejection of the meshwork and contraction of cutaneous-muscular and tarso-conjunctival layers. A two-stage surgical technique of lower eyelid retraction repair with full-thickness skin autograft from preauricular face zone using a spacer out of Ultrapro composite monofilament meshwork and autologous mucosa of the lip was used. At the first step deep scars were resected and lost volume of skin tissue was restored. At the second step spacer grafts were used for supporting purposes to provide structural support. As a result, vertical size of the lower eyelid was elongated in relation to the eyeball by 2.88 mm. In one year after surgery there was no significant difference in the distance between lower limbus and lower eyelid on both sides. There was good and stable functional and aesthetic result of surgery. This surgical approach gave a possibility to dose the effect of operation, to repair retraction of the lower eyelid, to restore an adequate adaptation of the eyelids and to reduce the vertical size of the eye slit without sufficient change of its horizontal size as well as to prevent keratopathy. Key words: lower eyelid retraction, ectropion, entropion, spacer graft

ABSTRACT Purpose To disclose the precise attachment site of the orbital septum in the lateral canthus. Methods Nine specimens of 7 Japanese cadavers aged 66 to 85 years at death were included. The attachment site of the orbital septum in the lateral canthus was grossly dissected. Two of the 9 specimens were exenterated and used to explore the anatomy from lateral and superior aspects, respectively. Results The orbital septum in the lateral canthus attached slightly lateral to the outer edge of the lateral commissure with the levator aponeurosis and the lower eyelid retractors in the upper and lower regions, respectively. In addition, the orbital septum attached to the arcus marginalis with regard to the orbital bone. Fat tissue occupied the space between the orbital septum and the lateral retinaculum. Conclusion The orbital septum in the lateral canthus attached around the lateral commissure and the orbital rim.

Relevance. Lower lid retraction is a frequent undesirable result following inferior rectus recession operations. Especially in relatively larger amounts of recession, a special and close relationship between lower lid retractors and muscular fascia makes the complication more severe. Purpose of the study. To introduce two methods that allow wide inferior rectus recession without causing lower eyelid retraction and to evaluate the long-term results. Material and methods. There were 25 cases and 18 control group cases in first operation technique named ‘ninety percent of posterior fibers recession of inferior rectus’ which can be perform for any vertical deviation without muscle fibrosis; and 8 cases were in second operation technique which named ‘muscle elongation with both organic tissue and non-absorbable suture’. Results and conclusion. In both technique patients’ deviation corrected and all ocular movement was free. Both operation techniques, which introduces by us, does not affected lower lid retractor and operations has both effective results and no lid problem.

To determine the degree of static eyelid asymmetry required to be perceptible and whether this is affected by image inversion. Images of 3 volunteers were digitally manipulated to have eyelid asymmetry of 0.5 mm, 1 mm, or 1.5 mm of 3 different types, upper lid ptosis, upper lid retraction, and lower lid retraction. Forty-nine laypersons stated whether the images were symmetrical or asymmetrical. A separate inversion survey, completed by 29 clinicians, consisted of symmetrical images and 1 mm asymmetrical images, with half being inverted. Upper lid ptosis, upper lid retraction, and lower lid retraction were not detected by most laypeople at 0.5 mm of severity (18.9%, 6.7%, 18.9% detection, respectively) but all 3 were detected by the majority of participants once asymmetry reached 1 mm severity (65.7%, 61.8%, 51.0% detection, respectively) and rose to over 70% identification at 1.5 mm (92.2%, 73.5%, 73.5% detection, respectively). Inversion of the images led to 19.7% lower rates of correct identification of asymmetrical faces compared with images presented in the correct orientation (80.7% asymmetry identified in normal images, 61.0% inverted, p < 0.001). All asymmetries were detectable by a majority of laypersons at a severity of 1 mm. Image inversion decreases a clinician's ability to detect a 1 mm asymmetry, indicating an impaired asymmetry perception in the intraoperative view. This study provides research to counsel patients with varying degrees of eyelid asymmetry.

Lower eyelid suspension, a common therapeutic procedure for facial paralysis-induced eyelid retraction, faces challenges due to high recurrence in patients lacking facial muscle function and impedes wider adoption. This research aims to explore the potential effects of restoring orbicularis oculi muscle tension through facial nerve reanimation prior to lower eyelid suspension and to define the indications for lower eyelid suspension. The study encompassed 32 individuals with complete facial paralysis, segmented into group A (reanimation group) and group B (non-reanimation group), based on whether the orbicularis oculi muscle's tension was restored through facial nerve reconstruction prior to lower eyelid suspension. Subjective assessments of eyelid closure (the inter-eyelid gap upon gentle closure) and objective methods measures of scleral show (the distance from the pupil's center to the lower eyelid margin, MRD2) were used to provide a comprehensive analysis of long-term effectiveness. The group A exhibited significantly greater long-term improvement in lagophthalmos and lower eyelid ectropion. The alterations in MRD2 measured 2.66 ± 0.27mm in the group A versus 2.08 ± 0.53 mm in the group B, denoting a statistically significant variance (p < 0.001). Moreover, while the ratio of MRD2 preoperative 6 months postoperative revealed no significant difference between groups, a significant difference emerged in 12 months postoperative (group A: 1.02 ± 0.21; group B: 1.18 ± 0.24; p < 0.05), with the values in group A closer to 1, indicative of enhanced symmetry. Restoring the tension in the orbicularis oculi muscle through facial nerve reconstruction prior to palmaris longus tendon sling could effectively sustain long-term outcomes of lower eyelid retraction correction and reduce the recurrence rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background The eyes are the central aesthetic unit of the face. Maxillofacial trauma can alter facial proportions and affect visual function with varying degrees of severity. Conventional approaches to reconstruction have numerous limitations, making the process challenging. The primary objective of this study was to evaluate the application of three-dimensional (3D) navigation in complex unilateral orbital reconstruction.Methods A prospective cohort study was conducted over 19 months (January 2020 to July 2021), with consecutive enrollment of 12 patients who met the inclusion criteria. Each patient was followed for a minimum period of 6 months. The principal investigator carried out a comparative analysis of several factors, including fracture morphology, orbital volume, globe projection, diplopia, facial morphic changes, lid retraction, and infraorbital nerve hypoesthesia.Results Nine patients had impure orbital fractures, while the remainder had pure fractures. The median orbital volume on the normal side (30.12 cm3; interquartile range [IQR], 28.45–30.64) was comparable to that of the reconstructed orbit (29.67 cm3; IQR, 27.92–31.52). Diplopia improved significantly (T(10) = 2.667, p = 0.02), although there was no statistically significant improvement in globe projection. Gross symmetry of facial landmarks was achieved, with comparable facial width-to-height ratio and palpebral fissure lengths. Two patients reported infraorbital hypoesthesia at presentation, which persisted at the 6-month follow-up. Additionally, five patients developed lower lid retraction (1–2 mm), and one experienced implant impingement at the infraorbital border.Conclusion Our study provides level II evidence supporting the use of 3D navigation to improve surgical outcomes in complex orbital reconstruction.