Isolated Medial Orbital Fracture with Medial Rectus Entrapment: A Case Report

Post-traumatic orbital fractures are common facial injuries, but isolated medial orbital wall fractures are rare and often underdiagnosed. These fractures can result in significant functional impairments, especially when complicated by extraocular muscle entrapment. We report the case of a 43-year-old woman who sustained an isolated medial orbital wall fracture with entrapment of the medial rectus muscle following an assault. She presented with diplopia, strabismus, and restricted ocular motility. CT imaging confirmed the fracture and medial rectus entrapment, which was further assessed by MRI. Surgical management was performed via a transconjunctival approach, involving muscle release and reconstruction with a titanium mesh. Postoperatively, the patient regained orthotropia in primary gaze, although mild motility limitation and diplopia persisted. Isolated medial orbital wall fractures can be easily overlooked, particularly when classic signs like enophthalmos are absent. However, muscle entrapment represents a surgical emergency to prevent permanent dysfunction. This case underscores the crucial role of early radiological evaluation and timely surgical intervention in optimizing functional outcomes. Early diagnosis and intervention are essential to minimize long-term morbidity.