A 10-year-old child presents with diplopia and limited elevation of the right eye after a sports injury. CT orbit shows an inferior orbital wall fracture with a 'trap-door' morphology and herniation of the inferior rectus muscle. The most appropriate management is:
- A Urgent surgical repair within 24–48 hours to prevent muscle ischaemia and permanent fibrosis ✓
- B Conservative management with oral steroids and monitoring for 4–6 weeks
- C Strabismus surgery after 6 months once scarring stabilizes
- D Enucleation due to risk of endophthalmitis from contaminated sinuses
Correct answer: A. Urgent surgical repair within 24–48 hours to prevent muscle ischaemia and permanent fibrosis
Explanation
Trapdoor orbital floor fractures in children (greenstick pattern where the bone springs back and traps soft tissue) are an ophthalmological emergency. The entrapped inferior rectus muscle and surrounding orbital fat undergo ischaemic necrosis rapidly, leading to permanent fibrosis and restricted motility if not released promptly. Unlike adults, waiting is contraindicated — surgical repair within 24–48 hours provides the best functional outcome. Associated oculocardiac reflex (bradycardia/nausea from entrapment) is another indication for urgent surgery.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.