1/37. Management of traumatic luxation of the globe. A case report.PURPOSE: To report the management of a patient who had LeFort type III fractures and traumatic luxation of the globe with avulsion of the optic nerve and all extraocular muscles except for the medial rectus. methods: Eight hours after the trauma, the detached and retracted superior and lateral recti muscles could be found and sutured to their original insertions. The inferior rectus could not be retrieved. RESULTS: Although the left eye had no light perception, most of its motility was restored resulting in an unblemished cosmesis. CONCLUSION: Avoiding primary enucleation helped to alleviate the psychological burden of the trauma on the patient. In case of the eventual development of phthisis bulbi, the patient will have a chance to be fitted with a prosthesis over his own eye with a resulting better motility.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/37. Treatment of traumatic cyclodialysis with vitrectomy, cryotherapy, and gas endotamponade.An aphakic patient with severe chronic hypotony had an alternative treatment of a traumatic cyclodialysis cleft: a 3-port pars plana vitrectomy, cryotherapy of the cleft, and fluid-gas exchange with subsequent supine positioning. The therapeutic principle was mechanical apposition of the detached ciliary muscle to the scleral spur by the gas bubble and scar induction by cryotherapy. intraocular pressure increased to within normal ranges, and visual acuity improved over a 15 month follow-up.- - - - - - - - - - ranking = 0.5keywords = muscle (Clic here for more details about this article) |
3/37. Traumatic rupture of the medial rectus muscle.Traumatic rupture of an extraocular muscle, in the absence of significant injury to the globe and adnexa, is uncommon. We report the case of a patient with an isolated mid-belly rupture of the medial rectus muscle following ocular trauma and describe the technique of repairing the ruptured muscle by suturing the distal segment to the Tenon sleeve of the proximal segment. This was combined with postoperative botulinum toxin injection to the ipsilateral lateral rectus muscle. Good primary position alignment was achieved 7 months after surgery. The patient regained a useful horizontal field of binocular single vision totaling 27 degrees.- - - - - - - - - - ranking = 4keywords = muscle (Clic here for more details about this article) |
4/37. Ophthalmic complications after surgery for nasal and sinus polyposis.PURPOSE: To describe ophthalmic complications after nasal and sinus surgery. methods: Four cases with orbital complications were retrospectively selected from among more than 2000 cases of orbital pathologies. RESULTS: Motility disturbances due to extraocular muscle injury occurred in two patients after intranasal ethmoidectomy and in one patient after a Caldwell-Luc procedure. In the fourth case an orbital apex syndrome was noted after intranasal ethmoidectomies. CONCLUSIONS: Ophthalmic complications may occur after nasal and sinus surgery, even using an endoscopic procedure. Successful handling of these complications could be reached by on their early recognition and treatment.- - - - - - - - - - ranking = 0.5keywords = muscle (Clic here for more details about this article) |
5/37. A case of traumatic globe luxation.We observed a case of traumatic globe luxation. A 26-year-old man who was sitting at the back seat of the car without fastening his safety belt was admitted to the emergency room after an automobile accident. He was in semi-comatose condition. His left globe was dislocated anteriorly, and the lids were tightly closed behind it. No laceration was observed in cornea, sclera and extraocular muscles. The pupil was dilated and did not respond to light stimulation. Computerized tomography scan analysis revealed a normal optic nerve, but multiple fractures in the nasal, inferior and temporal walls of the orbit and in the nasal bone. Phthisis of the eye was detected by the end of second month. We believe that the back seats of automobiles should also be furnished with air bags for better security of passengers.- - - - - - - - - - ranking = 0.5keywords = muscle (Clic here for more details about this article) |
6/37. strabismus due to flap tear of a rectus muscle.PURPOSE: To present a previously unreported avulsion-type injury of the rectus muscle, usually the inferior rectus, and detail its diagnosis and operative repair. methods: Thirty-five patients underwent repair of flap tears of 42 rectus muscles. The muscle abnormality was often subtle, with narrowing or thinning of the remaining attached global layer of muscle. The detached flap of external (orbital) muscle was found embedded in surrounding orbital fat and connective tissue. Retrieval and repair were performed in each case. RESULTS: Fourteen patients had orbital fractures, 7 had blunt trauma with no fracture, and 9 had suspected trauma but did not undergo computed tomographic scan. Five patients experienced this phenomenon following retinal detachment repair. Diagnostically, the predominant motility defect in 25 muscles was limitation toward the field of action of the muscle, presumably as a result of a tether created by the torn flap. These tethers simulated muscle palsy. Seventeen muscles were restricted away from their field of action, simulating entrapment. The direction taken by the flap during healing determined the resultant strabismus pattern. All patients presenting with gaze limitation toward an orbital fracture had flap tears. The worst results following flap tear repair were seen in patients who had undergone orbital fracture repair before presentation, patients who had undergone previous attempts at strabismus repair, and patients who experienced the longest intervals between the precipitating event and the repair. The best results were obtained in patients who underwent simultaneous fracture and strabismus repair or early strabismus repair alone. CONCLUSIONS: Avulsion-type flap tears of the extraocular muscles are a common cause of strabismus after trauma, and after repair for retinal detachment. Early repair produces the best results, but improvement is possible despite long delay.- - - - - - - - - - ranking = 7keywords = muscle (Clic here for more details about this article) |
7/37. Attempted bilateral manual enucleation (gouging) during a physical assault.OBJECTIVE: To report a rare, severe case of partial traumatic bilateral enucleation and its assessment and management. DESIGN: Case report and literature review. methods: A report of clinical and imaging findings, surgical procedure, medical treatment, and final outcome. RESULTS: Complete avulsion of the extraocular muscles and optic nerve resulted in total loss of vision in one eye. Partial visual recovery was achieved by operating on the fellow eye, which was partially avulsed. Both eyes underwent lateral canthotomy in the emergency room. This was followed by exploration, repair of all ruptured extraocular muscles, and anterior chamber tap under general anesthesia. The few previously reported cases of traumatic manual avulsion of the globe are reviewed and discussed in the context of the present case. CONCLUSIONS: Partial visual recovery can be achieved after severe orbital and optic nerve trauma. A multidisciplinary approach to the assessment and management of these patients is recommended.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
8/37. Reconstruction of an inner layer defect of the upper eyelid with avulsion of the superior levator palpebrae muscle and orbital fat.The authors report a successful reconstruction of the total upper eyelid in conjunction with the gliding surface of the extraocular muscles. A 21-year-old woman sustained an inner layer defect of her right upper eyelid together with avulsions of the superior levator palpebrae muscle and the superior orbital fat. Her right superior rectus muscle was exposed, and no orbital fat was seen in the space between the muscle and the orbital roof. To preserve eye movement, a gliding surface between the superior rectus muscle and the orbital roof had to be reconstructed. Total upper lid reconstruction was performed using a radial forearm flap with a hard palate mucosal graft. The gliding surface was reconstructed with an adipofascial flap obtained from the forearm. Despite lack of levator function, the patient could raise her eyelid approximately 5 mm by using only the superior rectus muscle without frontalis suspension.- - - - - - - - - - ranking = 5keywords = muscle (Clic here for more details about this article) |
9/37. Traumatic globe luxation.A case of globe luxation which followed a relatively slight trauma is presented. The luxation was accompanied by laceration of the conjunctiva in this case. After achieving reposition in the emergency room, the patient underwent a surgical exploration of extraocular muscles and conjunctival fornices where many eyelashes were removed. The clinical features and management of globe luxation is discussed, importance of surgical exploration is emphasized.- - - - - - - - - - ranking = 0.5keywords = muscle (Clic here for more details about this article) |
10/37. Evaluation of ocular changes secondary to blowout fractures.There has been extensive debate over the standard of care of orbital fractures. Entrapment, diplopia, and hypoglobus, with or without enophthalmos, are the most common clinical indications for surgical intervention. Evaluation of these injuries is often limited in the early postinjury period because of edema. In assessing the severity of the injury, the clinician often uses parameters such as changes in visual acuity, patient-reported diplopia, gross changes in globe position, and an evaluation of the extraocular muscles. Many of these parameters are only grossly assessed and therefore are not specifically documented and tracked. The decision to proceed with surgical intervention may be based only on these gross clinical findings. The purpose of this article is to present a reliable and repeatable method for evaluating the degree of diplopia and the globe position of the orbital trauma patient by describing the use of the double Maddox rod test (Wilson Ophthalmic, Mustang, OK) and Hertel exophthalmometer (Wilson Ophthalmic). These methods can provide sequential documentation of the progression of the injury and help better define the need for surgical intervention and to follow the postoperative course.- - - - - - - - - - ranking = 0.5keywords = muscle (Clic here for more details about this article) |
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