Pediatric orbital floor fracture : direct extraocular muscle involvement
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Updated: Oct 11, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
J E Egbert1, K May, R C Kersten
1University of Minnesota, Department of Ophthalmology, Minneapolis, Minnesota 55455-0501, USA.
Insights
Pediatric orbital floor fractures often involve inferior rectus muscle entrapment, causing pain and motility issues. Early surgical repair within seven days significantly improves symptoms and vision more rapidly than delayed surgery.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Trauma Surgery
Background:
- Orbital floor fractures are common in children, with varied presentations.
- Understanding the specific challenges in pediatric cases is crucial for optimal outcomes.
Purpose of the Study:
- To analyze the clinical features, surgical findings, and outcomes of isolated orbital floor fractures in pediatric patients.
- To identify factors influencing surgical success and recovery time.
Main Methods:
- Retrospective, consecutive case series of 34 pediatric patients (<18 years) with isolated orbital floor fractures.
- Surgical repair was performed for severe extraocular muscle limitation, enophthalmos, or both.
- Data collected included fracture cause, symptoms, clinical signs, radiographic findings, operative details, and postoperative results.
Main Results:
- Older children (>12 years) were more prone to fractures from violence.
- Pain with eye movements, nausea, and vomiting were common symptoms.
- Inferior rectus muscle entrapment occurred in 69% of patients with severe motility limitation.
- Early surgery (within 7 days) led to faster improvement in duction deficits and diplopia compared to later surgery (after 14 days).
- No vision loss or implant complications were reported.
Conclusions:
- Pediatric orbital floor fractures with severe motility limitation frequently involve inferior rectus muscle entrapment.
- Surgical intervention rapidly alleviates pain, nausea, and vomiting.
- Early surgical repair within 7 days is recommended for faster recovery of ocular motility and resolution of diplopia.
Objective:
To study the clinical presentation, operative findings, and postoperative results of a surgical series of isolated orbital floor fractures in children.
Design:
Noncomparative, retrospective, consecutive case series.
Participants:
Thirty-four patients (34 orbits) less than 18 years of age with isolated orbital floor fractures. Indications for surgery were severe limitation of extraocular ductions, 22 of 34; enophthalmos, 8 of 34: or both, 4 of 34.
Intervention:
Surgical repair.
Main Outcome Measures:
Cause of fracture, symptoms, clinical signs, radiographic data, operative findings, postoperative results, and complications.
Results:
Children older than 12 years of age were more likely to sustain an orbital floor fracture as a result of interpersonal violence than were children less than 12 years of age (P: = 0.020). Sixty-two percent of patients (21 of 34) exhibited pain with eye movements and/or nausea and vomiting. Most had a trapdoor type fracture (21 of 34). The inferior rectus muscle was entrapped in the orbital floor fracture in 69% (18 of 26) of patients with a severe limitation of ocular ductions. Preoperative nausea and vomiting were immediately relieved after surgery. The median time for improvement of preoperative duction deficits and diplopia was 4 days for patients receiving surgery within 7 days and 10.5 days for those undergoing surgery after 14 days (P: = 0.030). Resolution of duction deficits or diplopia was not dependent on time of surgery if performed within 1 month of injury. Loss of vision, worsening of motility, or implant complications did not occur.
Conclusions:
Pediatric patients with isolated orbital floor fractures who had pain, nausea, vomiting, and severe limitation of extraocular motility often have direct entrapment of the inferior rectus muscle into the fracture site. Surgical repair rapidly relieved preoperative pain, nausea, and vomiting. For patients with severe limitation of ductions, early surgical repair within 7 days of injury resulted in more rapid improvement of ductions and diplopia than surgery performed later.
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