The use of systemic corticosteroids in the treatment of orbital fractures: A systematic review

Topic To assess the effectiveness of systemic corticosteroids in patients aged 16 years or older with orbital fractures. Clinical Relevance Orbital fractures are a common consequence of facial trauma. Corticosteroids are frequently used perioperatively in such cases, but their clinical effectiveness and safety remain unclear. Evidence specific to orbital fractures remains limited. Methods We searched MEDLINE, Embase, CENTRAL, and Web of Science, following PRISMA reporting guidelines, for studies involving participants aged 16 years or older with clinically or radiologically confirmed orbital fractures treated with systemic corticosteroids versus placebo/standard care, between January 1999 and June 2025. No study-design filter was applied; RCT eligibility was assessed during screening. Screening and risk-of-bias assessment (Cochrane RoB 2/GRADE) were conducted by two reviewers independently, with any disputes resolved by a third reviewer. Due to heterogeneity in interventions and outcomes, a narrative synthesis was conducted. Results Three RCTs (58 patients analysed, out of 68 enrolled) were included. Two studies reported lower postoperative pain and periorbital swelling, respectively, with corticosteroids; one found no benefit in long-term neurosensory recovery. No adverse events were reported. Risk of bias was high in one study and raised some concerns in two, particularly regarding outcome measurement and masking. Certainty of evidence was rated low for all studies. The small number of trials, variation in steroid regimens, and outcome heterogeneity limited generalisability and precluded meta-analysis. Conclusion Evidence for systemic corticosteroids in orbital fractures is limited and low certainty. Adjunctive corticosteroids may provide short-term postoperative pain relief and reduced periorbital oedema, but the magnitude and certainty of benefit remain uncertain; no benefit for long-term neurosensory recovery was found. Further well-conducted trials are needed to clarify longer-term outcomes.