Background <p>Myopia is a growing public health issue, with the COVID-19 pandemic potentially accelerating its progression due to home confinement and increased near work. This study investigates the effectiveness of orthokeratology in controlling myopia during the strict home confinement period in Shanghai in 2022.</p> Methods <p>We conducted a retrospective study involving 139 myopic children who used orthokeratology before, during, and after the home confinement period and 91 children as a control group. Axial length (AL) was measured at three time points: before, during, and after home confinement.</p> Results <p>The axial length growth in the orthokeratology group was significantly lower during the home confinement period compared to the control group (0.102 ± 0.105&#xa0;mm/6 months vs. 0.199 ± 0.165&#xa0;mm/6 months, <i>p</i> &lt; 0.001). No significant differences were observed in axial length growth before, during, and after home confinement within the experimental group.</p> Conclusions <p>Orthokeratology remains effective in controlling myopia progression even during adverse conditions like home confinement, offering an important strategy for myopia control in high-risk environments.</p> Clinical trial registry <p><a href="http://www.chictr.org.cn/">http://www.chictr.org.cn/</a>; trial registration number: ChiCTR2000036969; date of registration: August 25, 2020.</p>