OBJECTIVE This study aimed to evaluate the clinical prognosis of diplopia and identify factors that are potentially predictive of residual diplopia postoperatively in pediatric patients with orbital blowout fracture. METHODS This was a retrospective study of clinical data from 135 children and adolescents less than 18 years of age who were diagnosed with orbital blowout fractures between January 2008 and June 2014 in the Department of Ophthalmology. A Kaplan-Meier curve and log-rank statistics were used to identify the recovery status from diplopia. Univariate and multivariate Cox proportional hazards analyses were conducted to identify the characteristics associated with residual diplopia. RESULTS Recovery from diplopia was rapid and obvious within 1 year after surgical repair; nearly 80% of the patients were cured of diplopia at that time point, according to the curve. Approximately 85% of the patients would completely recover from diplopia over time, and the remaining patients would most likely have residual diplopia. Multivariate analysis demonstrated that patient age (p < 0.001), the time interval between injury and surgery (p < 0.001) and preoperative muscle swelling (p = 0.028) were factors predictive of residual diplopia. CONCLUSIONS Early intervention in pediatric patients with orbital blowout fracture is recommended to reduce the rate of residual diplopia. Swelling of the ocular muscle and younger age may result in a prolonged recovery time and a lower recovery rate from diplopia after surgery. The recovery from diplopia in pediatric patients appears to be stable 1 year after surgical repair. Therefore, a follow-up time of at least 1 year is recommended for an overall evaluation of residual diplopia in children.