Diplopia following porous polyethylene orbital rim onlay implant.
An 81-year-old man with ocular irritation associated with lower eyelid retraction, horizontal laxity of the lower eyelids, and hypoplastic inferior orbital rims underwent bilateral placement of porous polyethylene orbital rim onlay implants. Two weeks after surgery, he developed vertical binocular diplopia on downgaze. Examination of extraocular motility demonstrated limited infraduction OD. Surgical exploration revealed scarring in the anterior orbit between the inferior rectus pulley and the orbital implant. The orbital implant was found to lie higher than the inferior orbital rim. After surgical lysis of the scar and reduction of the vertical height of the implant, the patient's diplopia resolved. Orbital connective tissues critical to ocular motility may be abnormally superficial in orbital rim hypoplasia. Onlay grafts must be carefully placed so that they do not interfere with these tissues.
Goldberg
Robert A
RA
Division of Orbit and Oculoplastic Surgery, Department of Ophthalmology, Jules Stein Eye Institute/University of California, Los Angeles, Los Angeles, California 90095, U.S.A.
Li
Tina G
TG
Demer
Joseph L
JL
D000368:Aged; D000369:Aged, 80 and over; D004172:Diplopia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000601:surgery*; D020959:Polyethylene; D016062:Porosity; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D020959:Polyethylene