Orbital imaging demonstrates occult blow out fracture in complex strabismus

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Maria Carolina OrtubeJoseph L Demer

Abstract

While strabismologists are familiar with diagnostic evaluation of suspected blow out fractures, unsuspected blow out fractures may further complicate difficult cases of strabismus not clinically supposed to be related to orbital trauma. According to a prospective protocol, we studied five adults presenting with diplopia, and one with convergence-related asthenopia. No patient recalled or had any clinical suspicion of orbital fracture at initial evaluation. Surface coil magnetic resonance imaging of the orbits was performed at 312 microm resolution, slice thickness 2 mm. Quasicoronal images in central gaze were supplemented with eccentric gaze positions, and sagittal and axial images as indicated. Five patients had incomitant hypertropia, and one had abducens paralysis. Magnetic resonance imaging disclosed previously unsuspected blow out fractures in all six patients. Three patients had medial wall fracture, one bilaterally. Two patients had inferior wall fractures, and one inferomedial. Although only one patient had an extraocular muscle displaced into a sinus, all had evidence of orbital connective tissue distortion in the region of the rectus extraocular muscle pulleys influencing muscle paths. These effects altered the prese...Continue Reading

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Citations

Sep 1, 2010·Craniomaxillofacial Trauma & Reconstruction·Shantha AmrithGangadhara Sundar
Jul 17, 2013·Magnetic Resonance in Medical Sciences : MRMS : an Official Journal of Japan Society of Magnetic Resonance in Medicine·Katharina Erb-EignerPatrick Asbach
Nov 24, 2019·Ophthalmology·Linda R DagiHilda Capo
Sep 20, 2006·Otolaryngologic Clinics of North America·Philip D Kousoubris, David A Rosman
Dec 26, 2006·Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus·Ahmed AwadeinDavid L Guyton
Dec 21, 2021·Journal of Pediatric Ophthalmology and Strabismus·Manjushree BhateAbhimanyu Sharma

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