High-Dose Corticosteroid-Assited Conservative Management of Orbital Blow Out Fractures Without Extraocular Muscle Entrapment: A Two-Case Series

Introduction: Orbital blowout fractures may be accompanied by substantial edema and soft-tissue injury that complicate assessment of extraocular muscle involvement. Distinguishing true mechanical entrapment from potentially reversible post-traumatic soft-tissue restriction is important to avoid unnecessary orbital exploration. Case Illustration: Two patients presented following blunt facial trauma with right orbital blowout fractures, marked periorbital swelling, and orbital fat herniation into the maxillary sinus. Diplopia was absent in both cases, and the second patient had no rectus muscle entrapment on computed tomography. Both were managed conservatively with cold compresses and high-dose intravenous methylprednisolone 125 mg every six hours followed by tapering. After five and six days, respectively, facial and periorbital swelling markedly decreased, ocular movements were documented in all directions, and neither patient reported diplopia or blurred vision. No orbital surgical exploration was performed. Discussion: Orbital fat herniation and severe edema should not automatically be interpreted as extraocular muscle entrapment. Serial clinical assessment after reduction of acute swelling may better identify patients who truly require reconstruction. Although corticosteroids may facilitate edema resolution, improvement cannot be attributed solely to steroid therapy in this uncontrolled case series. Conclusion: Corticosteroid-assisted conservative management may support reassessment of selected orbital blowout fractures without definite muscle entrapment and may help avoid premature surgery.