Ocular Motility Disturbances in Orbital Wall Fracture Patients

It is difficult to identify the exact cause of ocular motility disturbances in orbital wall fracture patients. By performing CT and ocular motility tests before and after surgery, this study analyzes the functions of the extraocular muscles and determines correlations between the results. Between February 2001 and January 2003, 45 eyes of 45 patients with orbital wall fractures, whose medical records could be traced back at least 6 months, underwent surgical repair in our hospital. All variables were analyzed using the independent t-test, paired t-test, and Chi-square test. There was no significant difference in the location and degree of fracture and the incarceration pattern of 6 patients who had moderate or severe diplopia, and of the remaining patients 6 months after surgery. However, in the case of diplopia, the sum of ocular motility limitation was 5.67 +/- 4.18, and the degree of extraocular motility disturbance was 3.67 +/- 2.42 before surgery. When there was no diplopia, the sum of ocular motility limitation was 1.13 +/- 1.38, and the degree of extraocular motility disturbance was 1.08 +/- 1.16 (p < 0.005, independent t-test). Ocular movement was successfully recovered by surgical reduction within 3 weeks from trauma. Postoperative ocular motility disturbance was more related to various ocular motility test results than CT findings. Ocular motility disturbances can remain after surgery if ocular motility limitation and extraocular motility disturbance are significant after trauma. Additional studies on the various tests to examine functions of extraocular muscles are required to identify and analyze the exact cause of ocular motility disturbance.

Ocular Motility Disturbance and Strabismus caused by High Myopia in Siblings

PURPOSE: Acquired ocular motility disturbance or strabismus in adult can be often diagnosed as paralytic strabismus, endocrine ophthalmopathy such as thyroid ophthalmopathy or myasthenia gravis etc. We present the diagnosis and treatment of two cases of high myopia with esotropia, hypotropia and abduction deficiency in siblings. METHODS: Two middle-aged women in siblings visited our hospital for evaluation of progressive esodeviation of eyeball. Ophthalmologic evaluations were performed including manifest refraction, duction test, prism cover test, fundus examination and ocular imaging study. Endocrinologic evaluations including thyroid function test and neostigmine test were also performed. RESULTS: Both patients had high myopia, esotropia and severe abduction deficiency, and one of them had hypotropia. Their thyroid function tests were normal and neostigmine test was negative. Ocular imaging study showed the orbits filled with the enlarged globes and lateral rectus muscles compressed by globes. Primarily, recession of bilateral medial rectus muslces was performed in both patients. Secondarily, recession of the ipsilateral inferior rectus muscle was performed in one patient who had hypotropia, and transposition of superior rectus muscle and inferior rectus muscle to lateral rectus muscle insertion site was performed in the other patient. The results were acceptable.

Analysis of Ocular Motility Disturbance remained After Open Reduction in Orbital wall Fracture

We evaluated 38patients with orbital wall fracture, who were repaired surgically after its diagnosis from January 1986 to October 1995. We analysed its clinical symptoms and signs, ocular motlity disturbances and strabismus remaining after reduction. All the aptients showed diplopia due to ocular motility disturbance, it was greater in the patients with large fracture size and inferior wall fracture. The ocular motility disturbance remaining after the reduction was proportional to the fracture size and the time between trauma and its reduction. The exotropia and hypertropia of the fracturd eye were the main types of strabismus remaining after reduction. It was more severe in the patients with large fracture size and upper grade of ocular motility disturbance. The weakening procedure of horizontal and vertical muscle resulted in good correction for the strabismus.