Orbital wall fractures may lead to extraocular muscle entrapment, a condition that requires timely diagnosis and intervention to prevent long-term functional deficits. While early repair is generally recommended, outcomes following delayed intervention remain variably reported. We describe a 27-year-old male who sustained a medial orbital wall fracture following a motor vehicle accident. Initial symptoms included diplopia, and impaired adduction of the left eye. CT imaging revealed a nondisplaced medial wall fracture with medial rectus entrapment. Despite clear radiographic findings, surgical intervention was delayed for approximately one week due to late follow-up. The patient subsequently underwent successful release of the entrapped medial rectus muscle via a transcaruncular approach. Postoperative follow-up demonstrated gradual improvement in ocular motility, with near-complete recovery at 4-week and full restoration of extraocular movement by three months. A postoperative CT scan at 3-month confirmed complete fracture healing and absence of recurrent herniation. This case highlights that, although early intervention remains the standard of care, delayed surgical release of an entrapped medial rectus muscle can still yield favorable functional outcomes when muscle viability is preserved. Careful clinical evaluation, appropriate imaging, and meticulous surgical technique are essential, particularly when diagnosis or referral is delayed. Timely recognition of extraocular muscle entrapment is critical. However, successful recovery is still achievable even with delayed repair. This case reinforces the importance of thorough assessment of persistent diplopia and motility deficits and demonstrates that delayed intervention can lead to full restoration of ocular function. • Medial rectus entrapment can occur in subtle medial orbital fractures causing diplopia. • Delayed surgery can still restore significant extraocular movement and function. • Clinical examination, remains essential alongside CT imaging for accurate diagnosis. • Transcaruncular approach allows safe access and and excellent visualization. • Persistent diplopia or gaze restriction after orbital trauma needs urgent referral.
Abdulfattah et al. (Wed,) studied this question.