An unexpected outcome of blunt ocular trauma: rupture of three muscles.
BACKGROUND
Traumatic strabismus due to isolated extraocular muscle rupture is uncommon. Treatment usually depends on the severity of both the subjective and objective findings.


METHODS
We report a male patient with restricted abduction and supraduction in the right eye follow ing a blunt ocular trauma. The exploration revealed the rupture of superior rectus, superior oblique, and lateral rectus muscles. Only lateral rectus muscle could be sutured to the proximal segment. Superior rectus and superior oblique muscles were severed brutally, so that repairing was not possible.


RESULTS
On the day after exploration and primary suturation, there was 25 prism diopters (PD) hypotropia and 15 PD esotropia in his right eye with severe limited supraduction and abduction. His major complaint was a large vertical diplopia which resolved partially with the prismatic glasses prescribed. After 6 months follow-up, medial rectus and inferior rectus recession was performed in the right eye. The patient had a limited but improved abduction after the operation. He was orthotropic and had a single binocular vision in the primary position.


CONCLUSIONS
In suspected extraocular muscle ruptures, orbital imaging methods and surgical exploration should be considered promptly. MRI may be mandatory to demonstrate the severed muscles in cases with persistent diplopia and normal CT. Prognosis is usually better in patients having partial extraocular muscle damage and treatment options should be evaluated on patient basis.
Sari
Ayça
A
Mersin University School of Medicine, Department of Ophthalmology, Mersin, Turkey. docayc@yahoo.com
Adigüzel
Ufuk
U
Ismi
Tulin
T
D000328:Adult; D005131:Eye Injuries; D005143:Eyelids / Q000293:injuries; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009801:Oculomotor Muscles / Q000293:injuries* / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D011184:Postoperative Period; D012421:Rupture; D013997:Time Factors; D014792:Visual Acuity; D014947:Wounds and Injuries / Q000175:diagnosis; D014949:Wounds, Nonpenetrating