Orbital fractures are a commonly encountered problem with 7-10% of patients developing delayed enophthalmos when managed conservatively with observation. To characterize the literature regarding incidence of delayed enophthalmos among patients with untreated unilateral isolated orbital wall fractures and determine what factors may predict this untoward outcome. Preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines were adhered to and a literature search was conducted using multiple medical subject headings (MeSH) headings. The publications were screened by two independent reviewers using the Critical Appraisal Skills Program (CASP) checklist and National Institute for Health and Clinical Excellence (NICE) quality assessment tools. Sixteen articles met criteria for inclusion in the study. The systematic review showed five factors that may affect development of delayed enophthalmos: linear measurements, involvement of specific intraorbital structures, rounding of the inferior rectus muscle, orbital fracture area, and volumetric analysis stratified by fracture site. There is a paucity of level I and II evidence driving the current management of orbital fractures that may lead to delayed enophthalmos. Additional prospective trials are needed to build upon the existing literature to improve the quality of care for this patient population.
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