Background <p>We investigated the long-term stability of ocular function and eyeball position after posttraumatic orbital reconstruction of patient-specific implants using alloplastic computer-aided design/computer-aided manufacturing (CAD/CAM). In this study, we evaluated the extent to which precise anatomical reconstruction contributes to stable functional and aesthetic outcomes over time.</p> Methods <p>Between 2010 and 2018, we retrospectively analyzed 69 patients who underwent orbital floor and medial wall reconstruction. The patients were classified into two groups following the implant type: CAD/CAM-manufactured titanium implants and standard CAD-based titanium implants. Long-term follow-up (LTFU) assessments included globe positioning, diplopia, motility, visual acuity, and intraocular pressure. The differences between the two groups were determined using statistical analyses.</p> Results <p>Deviations in the sagittal and vertical globe positions persisted after a median follow-up of 56 months in both groups, with no significant differences. Vertical globe deviation is significantly associated with diplopia. Patients with CAD-based implants showed a higher tendency for motility restriction and lower visual acuity than those with CAD/CAM implants. Intraocular pressure was significantly lower in the affected eyes in both groups.</p> Conclusion <p>CAD/CAM-designed implants provide improved anatomical reconstruction; however, they do not significantly improve long-term globe positioning than CAD-based implants. However, they may also contribute to improved motility and visual outcomes. A close interdisciplinary approach involving ophthalmologists is important for optimizing treatment planning and postoperative assessments.</p>