PURPOSE: To predict the surgical planning based on early-obtained computed tomography (CT) images of orbital medial wall fractures. METHODS: Early orbital medial wall fractures CT images were selected for retrospective study. The binocular proptosis, fracture area, and binocular interrectus distance were measured on a PACS workstation with line segment and irregular area measurement tools of the system. Medial rectus changes and intraorbital pneumatosis were observed. According to the obtained results, the cases were grouped, and the correlation analysis was carried out. RESULTS: 104 cases were divided into 6 groups by detailed classification of the characteristics. For cases with a relatively complete muscle cone structure, the difference in binocular proptosis was significantly correlated with the difference in binocular interrectus distance (P <
0.05), with a fitting linear regression equation of Y= -0.165 + 0.478*X (Y is binocular proptosis difference, X is binocular interrectus distance difference). CONCLUSION: Within the limitations of the study, based on early-obtained CT images of orbital medial wall fractures, detailed classification of the characteristics can predict clinical surgical planning. And restoring normal interrectus distance may be the key to restoring proptosis.