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.
Diagnosis ; Diplopia ; Exotropia ; Humans ; Orbit* ; Strabismus

A case of ocular cysticercosis which was successfully treated by surgical removal was presented in a 43-year-old man. Intractable diplopia and localized palpable mass in the nasal portion of the right upper eyelid were his chief complaints, that had been persisted for about 6 months. It was interesting that there were several episodes of dramatic improvement of those symptoms, and this delayed the decision of surgical treatment and its diagnosis.
Adult ; Cysticercosis* ; Diagnosis ; Diplopia ; Eyelids ; Humans

We compared the diagnostic accuracy of the simple x-ray with that of the computed tomography, and analyzed the surgical results according to the timing of operation in 52 patients with suspected orbital blowout fractures who complained diplopia after midfacial trauma. Of all the cases, 40 orbital fractures were confirmed with CT and forced duction test and the remaining 12 patients were thought to have transient functional impairment because the clinical signs were resolved with time. CT detected all the 40 actual fractures, so the dignostic accuracy(100%) was higher than that of the simple x-ray(75%) which detected 30 fractures of the 40 actual fractures(p=0.001). We operated 19 patients who have persistent diplopia, enophthalmos of more than 2 mm, and large fracture defect, and there was significant improvement of symptoms and signs in patients on whom operations were performed within 2 weeks after trauma rather than after 2 weeks.
Diagnosis* ; Diplopia ; Enophthalmos ; Humans ; Orbit* ; Orbital Fractures

Orbital fracture represents one of the common lesions encountered today with our modern mechanized life. Reduction of these fracture is important in preventing the untoward complications that may ensue such as diplopia and enopththalmos. Although various types of incision have been employed to approach the orbital floor and infraorbital rim, subcilliary and transconjunctival approach are most commonly used. The subcilliary approach has been used for a number of years successfully although it does have shortcommings such as cutaneous scar and ectropion in many cases. The conventional transconjunctival approach provides limited exposure, so it can be used only with small fractures. In order to avoid above problems, it is preferable to use a paracanthal transconjunctival incision: however, it is combined with severance of the lower limb of the lateral canthal tendon approximately 2mm from the canthus. We have used this technique in fifty one cases with diagnosis varying from blow-out fracture to extensive facial fracture. We found that this approach provides good exposure and gives an excellent postoperative result with a concealed apparent cutaneous scarring and no scleral or corneal complications and visualization of the orbital floor and rim with minimal morbidity and insignificant cosmetic impact. In contrast to previously reported similar approaches, it is simple to use in traumatic and congenital lesions that go beyond the orbital floor.
Cicatrix ; Diagnosis ; Diplopia ; Ectropion ; Lower Extremity ; Orbit* ; Orbital Fractures* ; Tendons

PURPOSE: To evaluate the incidence of persistent diplopia and enophthalmos and possible risk factors leading to their occurrence in patients who had orbital blowout fracture repair. METHODS: We retrospectively evaluated clinical features in 76 eyes of 76 patients with orbital blowout fracture, who were repaired surgically after its diagnosis from March 1995 to November 2001. We analysed the relationship between persistent diplopia and enophthalmos after reconstruction and timing of surgery, patient age, fracture location, fracture size and alloplast material. RESULTS: Postoperatively, 11 patients (22.9%) expirienced diplopia and enophthalmos persisted in 11 (28.2%) patients. Timing of surgery, patient age, fracture location, fracture size was found to be significant for the development of postoperative diplopia but alloplast material was not significant for the development of postoperative diplopia (p>0.05). Timing of surgery and fracture size was found to be significant for the development of postoperative enophthalmos but patient age, fracture location and alloplast material was not significant for the development of postoperative enophthalmos (p>0.05). CONCLUSIONS: We believe that timing of surgery is important prognostic factor that decreases the incidence of persistent diplopia and enophthalmos after surgical repair of blowout fracture. In addition, this study will provide important prognostic informations that can be of benefit to both patients and surgeon in performing surgical repair of blowout fracture.
Diagnosis ; Diplopia* ; Enophthalmos* ; Humans ; Incidence ; Orbit ; Retrospective Studies ; Risk Factors

Blowout fracture is a fracture of the bony orbital floor in the direction of the maxillary sinus as the result of a sudden increase of intra-orbital pressure secondry to a blow to the eye and soft tissue of the orbit from non penetrating convex objects. A common clinical manifestations of blowout fracture are enophthalmos, intra-orbital anesthesia, diplopia and mechanical limitation of ocular rotation. The early diagnosis and proper treatment of blowout fracture may prevent disability and deformity. Recently, we have repaired three cases of blowout fracture by use of the Cald-well-luc approach combined with the Subciliary incision. We report three cases of blowout fracture with a brief review of the literature.
Anesthesia ; Congenital Abnormalities ; Diplopia ; Early Diagnosis ; Enophthalmos ; Maxillary Sinus ; Orbit

Medial orbital wall fracture was described by Converse and Smith in the first time in 1957. These fractures which comprise more than 30% of all the orbital wall fracture are may easily be overlooked in routine orbital radiology. Accordingly, examination with orbital CT is essential for accurate diagnosis and appropriate treatment. These type of fracture are followed frequently by post-oprative complication such as diplopia and enophthalmos because it is very difficult to approach to orbital medial was in these operations. The mechanism of the orbital wall fractures are abruptly increased hydraulic pressure by sudden impact on orbital rim or soft tissue of orbital region. So patients who show the signs of subcutaneous emphysema, edema on the orbital region or diplopia need to get through examination with orbital CT for accurate diagnosis and immediate reconstruction of the fractured orbital wall. Conventional approaches in the operations of the orbital medial wall fractures are that with bicoronal incision, subciliary incision, transconjunctival incision and infra-orbital rim incision. But, approach with bicoronary incision, needs broader dissection and longer time for operation. Operations with transconjunctival incision and that with subciliary incision have difficulty to approach to fractured sites. Operations with other conventional methods may be also followed by scar problem. The authors performed reduction and reconstruction of the fractured orbital medial wall fractures successfully without any complications and difficulties by intra-eyebrow approach with which they made incision of 2 - 2.5 cm on mid-area of eyebrow to expose fractured medial wall with good operative field.
Cicatrix ; Diagnosis ; Diplopia ; Edema ; Enophthalmos ; Eyebrows ; Humans ; Orbit* ; Subcutaneous Emphysema

A 65-year-old man who had been experiencing diplopia in front and down gaze for 15 days visited our hospital. Hypertropia was noted in the patient's left eye, and limitation of depression was found in the adduction, primary gaze, and abduction. Brain magnetic resonance imaging showed no remarkable findings. Two weeks after the first visit, the patient complained of ptosis in the left eye. An ice test was performed and the ptosis was resolved after the test. Then, anti-acetylcholine receptor binding antibody levels were checked and found to be slightly elevated. We prescribed methylprednisolone per os 24 mg for 2 weeks, and his symptoms improved after the 2-week treatment. Five weeks after his first visit, the patient showed an ortho result in the alternate prism cover test and normal ocular movements. This may be the first case in which ocular myasthenia gravis presented as double depressor palsy, and in such cases, the possibility of ocular myasthenia gravis should be considered to rule out double depressor palsy.
Aged ; Diagnosis, Differential ; Diplopia/*diagnosis/*etiology ; Humans ; Male ; Myasthenia Gravis/*complications/*diagnosis ; Ocular Motility Disorders/diagnosis/etiology ; Strabismus/diagnosis/etiology

PURPOSE: To classify zygomatico-orbital fractures based on Zingg's classification and to evaluate the results of treatment. METHODS: Thirty patients who were diagnosed with zygomatico-orbital fracture between 2000 and 2004 were classified based on Zingg's classification, were treated and followed up for more than 3 months. Of the 30 patients, 28 received surgical treatment, including Gillies reduction or open reduction and rigid fixation with a microplate. RESULTS: The mean follow-up period was 6 months. Most of the patients were satisified with the results of surgery. There were no secondary operations due to facial asymmetry, secondary wound infection, microplate exposure or paresthesia. However, there were 3 re-operations for diplopia, enophthalmos, and lower eyelid retraction, respectively; the conditions had persisted until postoperative 2 weeks. CONCLUSIONS: The use of 3-dimensional Zingg's classification for zygomatico-orbital fractures appeared to be beneficial in making more accurate diagnoses and in determining surgical treatment. Oculoplastic approaches, including subciliary or transconjunctival incision, Gillies reduction and rigid fixation with a microplate, are considered to be good methods for the treatment of zygomatico-orbital fractures, as they are associated with exact anatomical and functional restoration and few complications.
Classification* ; Diagnosis ; Diplopia ; Enophthalmos ; Eyelids ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Paresthesia ; Wound Infection

PURPOSE: To report the clinical manifestations of patients with ocular tilt reaction (OTR) and the differential point from other disorders with abnormal head posture. METHODS: The clinical manifestations of four patients who complained of abnormal head posture and diplopia and who were diagnosed to have OTR from January, 2001 to January, 2002 were investigated. The diagnoses were made with alternate cover test, duction and version test, Lancaster test, Bielschowsky head tilt test, fundus photography, and brain MRI. RESULTS: All the four patients showed ipsilateral head tilt, ocular torsion, and vertical deviation. Type of their OTR was tonic OTR. Subjective tilting of visual vertical was observed in one patient. Only with the 3-step test, OTR could be misdiagnosed as an extraocular muscle palsy. The most important sign in differentiation from other disorders of abnormal head posture was ocular torsion. Duction and version examination and tilt of subjective visual vertical were also helpful for the differentiation. CONCLUSIONS: OTR should be considered in patients with ocular torsion, vertical deviation and ipsilateral head tilt. In patients with diplopia and head tilt, examination of ocular torsion should be performed with the 3-step test in order not to make a misdiagnosis of extraocular muscle palsy.
Brain ; Diagnosis ; Diagnostic Errors ; Diplopia ; Head ; Humans ; Magnetic Resonance Imaging ; Paralysis ; Photography ; Posture