SummaryThe purpose to this study was to determine whether early surgical repair is indicated for a severely entrapped inferior rectus muscle following orbital blowout fracture. We report two patients with small blowout fractures, severe entrapment of the inferior rectus muscle, and an absence of the inferior rectus muscle in multiple contiguous coronal computed tomography cuts. At surgery, we released the severely entrapped inferior rectus muscles with resolution of diplopia. We concluded that patients with the “missing muscle syndrome” require urgent surgical intervention and that clinician review of radiologic studies is always prudent.