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BACKGROUND: The management for blow-out fractures is controversial. Some studies suggest early surgical treatment, others a conservative attitude. PATIENTS AND METHODS: We studied retrospectively the data of patients with blow-out fracture, referred to our Neuro-Ophthalmology and Strabismus Clinic from July 1993-May 2000. Out of 48 patients, 22 were operated. We evaluated all 12 patients who underwent pre- and postoperative orthoptic examinations. RESULTS: The patients' age at the time of the accident was 7.8 to 67.8 years (median 25.3). The delay between accident and operation was 2 to 91 days (median 5.5). Eleven patients were operated within 14 days, one after three months. All patients suffered preoperatively from double-vision. Postoperatively the field of fusion augmented, the middle point centralised. The follow-up time was 22 to 915 days (median 251). However, at the last examination, 0.5 to 16 months (median 4.5) after surgery, only seven out of 12 patients were symptom-free. CONCLUSION: Surgical reconstruction within the first week after trauma shows good results concerning ocular motility, sensibility, enophthalme, and field of fusion. An individual evaluation is surely necessary.