Surgical Repair within 24 Hours Improves Ocular Motility in Pediatric Orbital Fractures with Muscle Entrapment:...

Pediatric orbital trapdoor and linear fractures may involve entrapment of the extraocular muscles (EOM), potentially causing irreversible ocular motility impairment if surgical intervention is delayed. The optimal timing for surgery in patients with EOM strangulation remains uncertain.

The authors retrospectively reviewed 103 pediatric cases identified from the medical records of 389 patients with orbital fractures. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Data from 10 previous studies and their institutional cohort were combined, including 101 patients younger than 20 years with radiologically confirmed EOM entrapment. Patients were stratified by time to surgery (within 24 hours, 24 to 72 hours, or after 72 hours).

Surgical intervention within 24 hours was significantly associated with better postoperative ocular motility outcomes compared with delayed surgery ( P < 0.05). In our cohort, patients treated within 8 hours achieved excellent recovery, with Hess area ratio exceeding 85% and no residual diplopia. Patients without EOM entrapment improved with an average of 7 weeks of conservative management.

This study supports urgent surgical repair within 24 hours for pediatric orbital fractures with EOM entrapment to maximize functional outcomes. In cases of soft-tissue entrapment without sustained oculocardiac reflex, nonoperative management with close follow-up may be appropriate. Prompt diagnosis and timely referral are critical to avoid permanent sequelae.