An optimal diagnostic proceeding in patients after orbital fracture with coexisting ocular movement disorders

Poster Details

First Author: KatarzynaSokalska POLAND

Co Author(s):                  

Abstract Details

Purpose:

The aim of this study is to prepare and evaluate a complex orthoptic proceeding in order to estimate indications for a surgical intervention in patients with orbital fracture causing ocular movement disorders.

Setting:

: The growing number of skull and face injuries, makes a proper diagnostic proceeding and treatment very valuable and requires a complex cooperation between medical professionals of many specializations. An ophthalmologist plays an important role in managing the patient on the level of emergency services

Methods:

78 patients were included in the study who underwent a head and orbital injury and subsequent procedure of orbital reconstruction. During the orthoptic examination Hertl’s egzoftalmometry and passive and active movement were performed. Ocular rotations ,the squint angle using a synoptophore in nine different gaze positions, and with use of a Hess’ screen were estimated. In cases of diplopia, the direction and its extent wewr analyzed using a perimeter (BSV) and red filter test. Finally the type of ocular movement disorder was established. Each patient was examined twice, before and three months after the reconstructive surgery. A scale based on diplopia direction and squint angle was set to access the recovery after reconstruction surgery.

Results:

In the whole group the time from the injury to medical intervention differed considerably. The average time was 79,35 days. Almost all patients suffered from orbital inferior wall fracture(97,4%). The most common type of preoperative ocular motility disorder was a simultaneous paralysis and a restriction of inferior rectus muscle, which was found in 35,9% of the examined patients. In the ocular motility examination revealed that the most common postoperative motility disorder is the isolated restriction of inferior rectus muscle (35,9%). Only in 3 patients (3,8%) after the injury reported no diplopia, while in 9 patients (11,53%) the double vision disappeared after the reconstruction procedure. The angle of squint decrease was observed in all gaze directions, whereas the change for the horizontal ocular deviation was not statistically significant (p=0,366). In ll patients who underwent the reconstruction procedure the motility disorders were established at the level 5 (31,57%) and the level 3 (28,94%) of the recovery scale.

Conclusions:

1. The optimal and complex diagnostic- proceeding in patients with orbital fracture should include the following examinations: the passive motility, diplopia evaluation, the measurement of the angle of squint in 9 sight directions, eye motility Hess chart test and the field of single binocular vision. The results of the mentioned procedures allows to predict the prognosis for patients subjected to the orbital reconstruction. 2. An early surgical intervention, a young age of the patient and the lack of straight or downward diplopia affect the postoperative result positively. 3. An unfavorable result of the surgical procedure may be expected in patients with ocular motility disorders (paralysis of the inferior rectus muscle) and with patients with a positive result of passive motility exam. 4. A large area of double vision found in the examination of the field of the single binocular vision and a growing vertical angles while looking upwards or downwards worsen the patient’s prognosis. FINANCIAL INTEREST: NONE