The present study reviews the long-term results of immediate reconstruction and primary grafting in 49 complex orbital fractures. The clinical features of these injuries are defined, and methods of investigation and surgical correction are outlined. The residual postoperative abnormalities, including enophthalmos, strabismus, and telecanthus, are critically analyzed. Recent modifications in fracture fixation, in orbital cavity reconstruction, and in the use of various types of autogenous grafts are discussed in detail.