To identify predictive factors for recovery time in patients with orbital fracture with diplopia through analysis of preoperative and postoperative computed tomography (CT) images and postoperative recovery time.

We retrospectively analyzed CT findings-preoperative: fracture size, type of fracture, fracture site, extraocular muscle (EOM) swelling, EOM and soft tissue injury, and the amount of soft tissue herniation; post-operative: degree of enophthalmos, and diplopia recovery period in 379 patients who underwent surgical treatment for orbital fracture between March 2006 and December 2015.

The average postoperative follow-up period was 556.2 ± 59.5 days, and the mean duration of recovery was 23.9 ± 42.5 (range, 3–186) days. The recovery time of diplopia was significantly increased with the following preoperative CT findings: fracture size (small and medium < large) ( p = 0.049), type of fracture (linear < hinge < comminuted, trap-door) ( p < 0.01), fracture site (inferior < medial and both) ( p < 0.01), EOM and soft tissue injury (prolapse and torsion, muscle entrapment, kinked muscle) ( p < 0.01), and the amount of soft tissue herniation (small and medium < large) ( p < 0.001). The mechanism of injury, sex, age, and the degree of enophthalmos were not related to the length of the diplopia recovery period.

The length of diplopia recovery could be predicted by CT findings.