Fractures to the middle third of the facial skeleton continue to increase in frequency secondary to motor vehicle accidents and interpersonal violence. Orbital floor fractures can occur either independently or may be associated with other facial bone fractures. Controversy has persistently surrounded the treatment of fractures to the floor of the orbit. We will present our investigation of 296 patients who sustained a total of 396 traumatic injuries to the orbit and were treated at the University of California, Davis Medical Center, Sacramento, California, during the period July 1, 1988 to June 30, 1989 to determine whether surgical exploration of the orbital floor is necessary or adds potential serious risks. In the 38 patients (46 orbits) who did not undergo surgical exploration of the orbital floor, 31 (82%) suffered serious residual complications. In the remaining group of 258 patients who underwent orbital floor exploration, there was a 7 percent incidence (18 patients) with residual sequelae. We conclude that exploration of the orbital floor has the potential to decrease the incidence of serious post-traumatic complications significantly, primarily enophthalmos.