Optimal Timing for Surgical Intervention in Orbital Fracture Management: A Systematic Review and Meta-Analysis

The optimal timing for surgical repair of orbital floor and combined orbital wall fractures remains a subject of clinical debate. While early surgery may prevent fibrosis, muscle entrapment, and enophthalmos, delayed intervention after edema resolution can sometimes yield comparable outcomes. This systematic review and meta-analysis aimed to evaluate the influence of surgical timing on functional and esthetic outcomes following orbital fracture repair.

The present systematic review followed PRISMA 2020 guidelines and was prospectively registered on PROSPERO (CRD42024502791). A comprehensive search across PubMed, Scopus, Elicit, Web of Science, ScienceDirect, Semantic Scholar, EBSCOhost, and Google Scholar identified relevant literature up to October 2025. Eligible studies included prospective and retrospective cohort designs comparing early (≤ 14 days) versus delayed (> 14 days) surgical repair. Risk of bias was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was rated via the GRADE framework. Quantitative synthesis was performed using a random-effects model.

Fifteen cohort studies encompassing 2666 patients were included. Early intervention (≤ 14 days) was consistently associated with superior recovery of diplopia and extraocular motility, particularly in fractures with muscle entrapment or large defects. Delayed repair beyond two weeks yielded acceptable results in select cases without entrapment. The risk of bias across studies was low to moderate, and the certainty of evidence was graded as moderate for most outcomes.

Early surgical repair within 7-14 days offers the most favorable functional recovery in orbital fractures, though individualized timing remains essential based on defect size, entrapment severity, and clinical presentation.