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Congenital Cranial Dysinnervation Disorder
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Inferior oblique paresis: Presence of superior oblique overaction with inferior oblique paresis pattern on Parks three-step test. Compensatory head tilt, A-pattern, and absence of restriction on FDT differentiate it from the Brown syndrome.Mono-elevation deficit: Restriction in elevation in both adduction and abduction along with component of ptosis or pseudoptosis.Blowout fracture: History of trauma with complaints of paresthesia and signs of enophthalmos is present. Restriction in elevation is more marked in abduction than in adduction.Thyroid eye disease: Restriction in elevation is more marked in abduction than in adduction along with other signs such as lid lag, lid retraction, and lateral flaring of the upper lid.Fat adherence syndrome: History of extraocular muscle surgery, especially inferior oblique. Also, restriction in elevation is more marked in abduction than in adduction.
Ocular trauma
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Mostafa Khalil, Omar Kouli, Rizwan Malik
An indirect blowout fracture to the orbital floor is commonly caused by a rapid increase in intraorbital pressure leading to compression of the globe posteriorly and a fracture of the orbital floor, typically the maxillary bone.
Orbital Fractures
Published in Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez, Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Regina M. Fearmonti, Jeffrey R. Marcus
A pure blowout fracture involves the internal orbital walls without fracture of the orbital rims. On examination, diplopia and enophthalmos are frequently evident. Diplopia is most often the result of edema but can result from incarceration of the inferior oblique or inferior rectus muscles, Lockwood’s ligament. Tenon’s capsule, or periorbital fat within the fracture line, any of which may lead to restricted ocular movement. Similarly, direct damage to the extraocular muscles or their innervations, hematoma, or edema can also lead to diplopia.
Evaluation of saccadic velocity in patients with orbital floor fracture before and after surgery
Published in Seminars in Ophthalmology, 2022
Ken Kakeue, Masanobu Kanazawa, Tatsuya Yunoki, Miharu Mihara, Atsushi Hayashi
The timing of the surgery is related to the outcome of the surgery. Several reports showed that surgery for an orbital blowout fracture was recommended within 2 weeks after injury.11–13 However, other researchers indicated that a delayed-surgery group (>2 weeks after the injury) improved to the same degree as the early-surgery group.14,15 In our present investigation, the average length of time from the patients’ injury to their surgery was 14.7 ± 9.4 days (range 0–29 days). In patients without entrapment, the increases in HAR, BSV, and saccadic PV did not differ significantly between the four patients within 2 weeks and the five patients with >2 weeks after injury. In a depressed fragment fracture of the orbital floor, relatively good results may be obtained even after ≥2 weeks if the appropriate surgical repair is performed. However, surgery within 48 hr is recommended for trap-door orbital fractures with strangled extraocular muscles,16,17 and the proper preoperative diagnosis is important.
Management of pediatric orbital wall fractures
Published in Expert Review of Ophthalmology, 2019
The other unique presentation is the white-eyed blowout fracture. The term was first coined by Jordan et al. [4] in 1998 and describes patients who have orbital floor fractures, a history of periocular trauma, marked extraocular motility restriction but no enophthalmos, minimal periorbital soft-tissue edema, no conjunctival hemorrhage, and negative or equivocal imaging findings. Pediatric patients who presented like this and who were operated on within 24–48 h had better long-term postoperative motility than did those who underwent the standard two-week waiting period [4]. Although there is a child’s limited cooperation, a thorough examination should be performed at the presentation if possible. In comparison with adults, children usually present with less periorbital edema and are able to undergo a full ophthalmologic examination [4,37]. Visual acuity, extraocular motility, forced ductions, and pupillary functions should be assessed for possible entrapment, muscle or nerve palsy, and optic neuropathy. A complete ophthalmic examination should be done if possible to look for traumatic corneal injury, hyphema, lens dislocation, lacrimal injuries, vitreous hemorrhage, retinal detachment, commotio retinae, and ruptured globe [44].
Complete inferior rectus muscle transection secondary to orbital blowout fracture
Published in Orbit, 2018
Jonathan M. Carrere, Kyle T. Lewis
Blunt orbital trauma is a common cause of orbital blowout fractures. Diplopia secondary to muscle entrapment, traumatic nerve damage, or edema of the surrounding tissues frequently occurs following blowout fracture. Additionally, penetrating trauma to the orbit can result rectus muscle laceration.1,2 In rare circumstances, complete transection of an extraocular muscle occurs after blunt trauma.3 We report a rare case of complete inferior rectus muscle transection following blunt orbital trauma. This report was performed in compliance with the Declaration of Helsinki, and patient information presented in accordance with HIPPA regulations.