Successful Conservative Management of a Blowout Fracture With Diplopia Using Self-Performed Manual Rehabilitation: A Case Report.

Early surgical intervention is generally recommended for blowout fractures presenting with diplopia or restricted ocular motility. We report a case of a blowout fracture in which diplopia and mild upward gaze limitation were observed immediately after the injury, but a favorable outcome was achieved through conservative management involving self-administered manual rehabilitation. The patient was a 59-year-old man who sustained facial trauma due to a fall. CT imaging revealed a blowout fracture with herniation of orbital contents into the maxillary sinus. Physical examination showed periorbital swelling, tenderness, and diplopia during upward gaze in the left eye, while visual acuity and other ocular movements remained normal. Although surgical repair was initially considered, the patient noticed that manually elevating the globe through the lower eyelid improved his diplopia and opted for conservative treatment. He performed daily manual globe elevation exercises. Within one month, the diplopia had almost completely resolved. Mild, intermittent recurrence occurred two months later but resolved promptly upon resuming the exercises. At the two-year follow-up, the patient had no symptoms of ocular motility disturbance or diplopia. This case suggests that self-performed manual globe elevation may serve as an effective conservative treatment option in selected cases of blowout fracture where surgical intervention is not feasible. Although further studies are warranted, this simple and noninvasive method may be useful in the management of post-traumatic diplopia.