PURPOSE: Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures. The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction. METHODS: A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil (ethisorb sheet or polydioxanone foil). A follow-up assessment including ophthalmological evaluation regarding visual acuity (eye chart projector), binocular visual field screening (Bagolini striated glasses test) and diplopia (cover test, Hess screen test) was conducted. Additionally, a questionnaire was performed to assess patients' satisfaction. RESULTS: A total of 53 patients with a mean follow-up of 23 months (ranging from 11 to 72) after surgical therapy were included. Diplopia was present preoperatively in 23 (43.4%) and reduced in follow-up examination (n = 12, 22.6%). Limitations in ocular motility reduced from 37.7% to 7.5%. The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters. CONCLUSION Transconjunctival approach is a safe approach for orbital fracture therapy. Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.
Cohort Studies ; Diplopia ; diagnosis ; etiology ; Follow-Up Studies ; Fracture Fixation ; methods ; Orbital Fractures ; complications ; physiopathology ; psychology ; surgery ; Outcome Assessment (Health Care) ; Patient Satisfaction ; Polydioxanone ; administration & dosage ; Polyglycolic Acid ; administration & dosage ; Retrospective Studies ; Surveys and Questionnaires ; Treatment Outcome ; Visual Acuity ; Visual Fields

Intraorbital wooden foreign bodies may present difficulties in diagnosis due to their radiolucent nature. Delayed recognition and management can cause significant complications. We present a case report that demonstrates these problems and the sequela that can follow. A 56-year-old man presented with a 3-cm laceration in the right upper eyelid, sustained by a slipping accident. After computed tomography (CT) scanning and ophthalmology consultation, which revealed no fractures and suggested only pneumophthalmos, the wound was repaired by a plastic surgery resident. Ten days later, the patient’s eyelid displayed signs of infection including pus discharge. Antibiotics and revisional repair failed to solve the infection. Nearly 2 months after the initial repair, a CT scan revealed a large wooden fragment in the superomedial orbit. Surgical exploration successfully removed the foreign body and inflamed pocket, and the patient healed uneventfully. However, the prolonged intraorbital infection had caused irreversible damage to the superior rectus muscle, with upgaze diplopia persisting 1 year after surgery and only minimal muscle function remaining. We report this case to warn clinicians of the difficulties in early diagnosis of intraorbital wooden foreign bodies and the grave prognosis of delayed management.
Anti-Bacterial Agents ; Delayed Diagnosis ; Diagnosis ; Diplopia ; Early Diagnosis ; Eye Foreign Bodies ; Eye Injuries, Penetrating ; Eyelids ; Foreign Bodies* ; Humans ; Lacerations ; Middle Aged ; Ophthalmology ; Orbit ; Prognosis ; Suppuration ; Surgery, Plastic ; Tomography, X-Ray Computed ; Wounds and Injuries

OBJECTIVE: To discuss the clinical features and treatment methods for simple orbital blowout fracture. METHOD: Retrospective analysis of the CT images of 16 orbital blowout fracture case, and identification of the sites, degree, patterns and features of fractures. Among the 16 cases, 2 cases adopted conservative treatment; 11 cases gained a reduction of orbital fracture through endoscopic transnasal surgery; the other 3 patients choosed endoscopic transnasal surgery and Caldwell-Luc operations. RESULT: Among 16 diplopia cases, 13 cases were completely cured, and 3 patients' vision were significantly improved. Among 11 enophthalmos cases, 10 patients were cured, and the effect of the other one was not satisfied. Among the 15 eye movement disorder cases, 13 patients' eye movement gained a full recovery, and the other 2 cases were nearly normal. All patients' vision were improved in different extents, and no one got a complication. CONCLUSION Computerized Tomography is helpful to the diagnosis of simple orbital blowout fracture. Caldwell-Luc operation with transnasal endoscope is an effective method for the treatment of orbital fractures.
Diplopia ; etiology ; Endoscopy ; Enophthalmos ; etiology ; Humans ; Orbital Fractures ; complications ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVE: To study surgical techniques and clinical applications of the intranasal endoscopic combined middle meatus and expand prelacrimal recess-maxillary ainus approach for orbital fracture treatment. METHOD: A retrospective clinical analysis of 3 patients whose admitted for orbital floor fractures or medial wall fractures operated by the intranasal endoscopic middle meatus with expand prelacrimal recess-maxillary ainus approach surgical treatment was studied, and the treatment effects and the postoperative complications were analyzed. RESULT: All patients had been followed up for 6 to 12 months. All cases of diplopia symptom were disappeared, enophthalmos were totally corrected, no cases of complication were found. CONCLUSION Endonasal endoscopic combined middle meatus and expand prelacrimal recess-maxillary ainus approach for orbital fracture treatment have great and clear view. This approach with less tissue damage and high therapeutic effect makes the cost lower than other methods and complications will be decreased as well, it has a great advantage in the orbital fracture treatment.
Diplopia ; etiology ; therapy ; Endoscopy ; Enophthalmos ; etiology ; therapy ; Humans ; Maxillary Sinus ; surgery ; Nose ; Ophthalmologic Surgical Procedures ; methods ; Orbital Fractures ; complications ; surgery ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies

Traumatic rupture of the superior oblique muscle is rare. We report a case of a 54-year-old man injured by the metal hook of a hanger, resulting in a rupture of the superior oblique muscle tendon. He complained of torsional diplopia when in the primary position. The distal margin of the superior oblique muscle was reattached to sclera 5 and 9 mm apart from the medial insertion of the superior rectus muscle. One week after the operation, torsional diplopia disappeared. However, a 4-prism diopter ipsilateral hypertropia was observed. Three months later, hypertropia gradually increased to 20 prism dioptors and the second operation was done to correct vertical diplopia.
Diplopia/etiology/physiopathology/surgery ; Eye Injuries/complications/*diagnosis/surgery ; *Eye Movements ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/*injuries/physiopathology/surgery ; Ophthalmologic Surgical Procedures/*methods ; Strabismus/etiology/physiopathology/surgery ; Tendon Injuries/complications/*diagnosis/surgery

OBJECTIVE: To evaluate the oblique angle, diplopia and stereoacuity before and after rectus recession-suspension on posterior sclera surgery in patients with restrictive strabismus caused by thyroid associated ophthalmopathy (TAO). METHODS: Data from 18 patients (19 eyes) with restrictive strabismus caused by TAO, who underwent rectus recession-suspension on posterior sclera surgery from July 2010 to June 2013 in Xiangya Hospital, Central South University, were analyzed retrospectively. Eight patients (8 eyes) or 5 patients (5 eyes) with hypotropia were operated with inferior rectus recession or superior rectus recession. Two patients (2 eyes) with esohypertropia or 3 patients (4 eyes) with esotropia were operated with inferior rectus recession plus medial rectus recession or medial rectus recession. Two patients (1 hypotropia, 1 esotropia) underwent orbital decompression surgery before strabismus surgery. All patients were performed rectus recession-suspension on posterior sclera surgery, and the oblique angle, diplopia view and stereopsis test were examined before and after the operation. RESULTS: All patients were followed up for more than 6 months. The preoperative prism were 20(Δ)- 80(Δ) and postoperative prism were 2(Δ)-10(Δ). There was diplopia on the primary position before surgery in 16 patients. After surgery, the diplopia in 14 patients disappeared on the primary and 15° down gaze, and 2 patients had not diplopia on the primary position but residual diplopia on inferior field. Two patients had stereopsis before surgery, and the numbers of patients raised to 14 after surgery. Compared with pre-operation, changes of the above measured indexs in post-operation were significant difference (all P<0.05). CONCLUSION The rectus recession-suspension on posterior sclera surgery is effective to improve oblique angle and diplopia in restrictive strabismus caused by TAO, which can improve patient's living quality.
Decompression, Surgical ; Diplopia ; Graves Ophthalmopathy ; complications ; Humans ; Oculomotor Muscles ; surgery ; Ophthalmologic Surgical Procedures ; methods ; Retrospective Studies ; Sclera ; surgery ; Strabismus ; surgery ; Treatment Outcome ; Visual Acuity

PURPOSE: To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors. METHODS: We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months. RESULTS: Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request. CONCLUSIONS: Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.
Adult* ; Brain Neoplasms ; Diplopia ; Fistula ; General Surgery ; Humans ; Myasthenia Gravis ; Oculomotor Nerve ; Paralysis ; Retrospective Studies ; Strabismus* ; Trochlear Nerve Diseases ; Wounds and Injuries

Epiduroscopic laser discectomy and neural decompression (ELND) is known as an effective treatment for intractable lumbar pain and radiating pain which develop after lumbar surgery, as well as for herniation of the intervertebral disk and spinal stenosis. However, various complications occur due to the invasiveness of this procedure and epidural adhesion, and rarely, cranial nerve damage can occur due to increased intracranial pressure. Here, the authors report case in which double vision occurred after epiduroscopic laser discectomy and neural decompression in a patient with failed back surgery syndrome (FBSS).
Cranial Nerves ; Decompression ; Diplopia ; Diskectomy ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc ; Intracranial Pressure ; Spinal Stenosis ; Trochlear Nerve ; Trochlear Nerve Diseases

PURPOSE: Residual head tilt has been reported in patients with superior oblique muscle palsy (SOP) after surgery to weaken the inferior oblique (IO) muscle. The treatments for these patients have not received appropriate attention. In this study, we evaluated the superior rectus (SR) muscle recession as a surgical treatment. METHODS: The medical records of 12 patients with SOP were retrospectively reviewed. Each of these patients had unilateral SR muscle recession for residual head tilt after IO muscle weakening due to SOP. The residual torticollis was classified into three groups on the basis of severity: mild, moderate, or severe. Both IO muscle overaction and vertical deviation, features of SOP, were evaluated in all patients. The severity of the preoperative and postoperative torticollis and vertical deviation were compared using a paired t-test and Fisher's exact test. RESULTS: The torticollis improved in nine of 12 (75%) patients after SR muscle recession. The difference between the preoperative and postoperative severity of torticollis was statistically significant (p = 0.0008). After surgery, the mean vertical deviation was significantly reduced from 12.4 prism diopters to 1.3 prism diopters (p = 0.0003). CONCLUSIONS: Unilateral SR muscle recession is an effective method to correct residual head tilt after IO muscle weakening in patients with SOP. This surgical procedure is believed to decrease head tilt by reducing the vertical deviation and thereby the compensatory head tilt.
Adolescent ; Adult ; Child ; Child, Preschool ; Diplopia/*surgery ; Female ; Head Movements ; Humans ; Infant ; Male ; Oculomotor Muscles/*surgery ; Retrospective Studies ; Strabismus/*surgery ; Torticollis/*surgery ; Treatment Outcome ; Trochlear Nerve Diseases/*surgery

OBJECTIVE: To explore the operative method and effect of fracture of orbital floor defects repaired with tragus cartilage through Cald-well-Luc approach under nasal endoscope. METHOD: Fifteen cases suffered fracture of orbital floor defects(blow out fracture) were analyzed retrospectively. Oral vestibular incision were done directly to tip teeth kennel, maxillary sinus anterior forewall was chiseled with 2 cm x 2 cm size, orbital floor fracture defect size was probed under nasal endoscope, and the fracture of orbital floor defects was repaired with tragus cartilage. RESULT: Fifteen cases were successfully operated and no cases showed vision loss,diplopia, enophthalmos obviously after operation,while 3 case were a little eyeball limitation of activity and restored basically after one month. With two years of follow up, there were no spurious eyelid drooping, up-eyelid lacuna deepen, eyelid diameter shorten and facial deformity were found. Both eye-balls were basical symmetry and no complications were happened. CONCLUSION It is a satisfactory, effective and aminimally invasive surgical method without facial scars and eyelid ectropion for fracture of orbital floor defects repaired with tragus cartilage through Cald-well-Luc approach under nasal endoscope.
Adult ; Blindness ; Cartilage ; transplantation ; Diplopia ; Ear Auricle ; Endoscopes ; Endoscopy ; methods ; Enophthalmos ; Female ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged ; Nose ; Orbital Fractures ; surgery ; Retrospective Studies