The eye globe volume is 7 cc, while the orbital volume is 30 cc, so this means that it is not just spanning the orbit but it is suspended inside it, three mechanisms control this accurate position; the intact bony framework, the ligamentous structures suspending the globe (through its attachment to the bony framework) and the volumetric balance between the eye globe (with its periorbital tissues) and the orbit.
In severe orbital fracture, ocular malposition occurs due to loss of integrity of one or more of the above three mechanisms. So it is not questionable why some patients with perfect orbital bony restoration still have ocular malposition mainly enophthalmos and less commonly dystopia.
Nevertheless, perfect bony restoration is the primary goal before proceeding to other maneuvers.
In the blow-out fractures, discussion about timing of surgery of orbital floor fractures, indications, type of reconstructive material and the surgical approach are controversial.