An Unexpected Outcome of Blunt Ocular Trauma: Rupture of Three Muscles

Sari, Ayca; Adigüzel, Ufuk; Ismi, Tulin

doi:10.1080/09273970903126543

Cited by 14 publications

(9 citation statements)

References 14 publications

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“…In previous reports, both CT and magnetic resonance imaging (MRI) have been useful for preoperatively evaluating lacerated muscles. [2][3][4][5][6][7] In the current case, we were able to find the posterior portion of the lacerated medical rectus muscle with the aid of preoperative CT and repair it. MRI may be more useful for characterizing the shape of a muscle than CT.…”

Section: Discussionmentioning

confidence: 71%

Successful Repair of a Traumatic Medial Rectus Laceration with the Aid of Computed Tomography

Obata

Higashiyama

Nishida

et al. 2015

Neuro-Ophthalmology

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A 79-year-old woman suffered ocular trauma from an umbrella. Exotropia of the left eye was observed, and the left eye could not adduct to the midline. Both edges of the lacerated medial rectus were sutured together with the aid of preoperative computed tomography (CT), which showed posterior muscle belly widening due to posterior slippage toward the equator. The alignment and ocular movement were improved postoperatively. Repairing a lacerated medial rectus is difficult because its edge slips into the muscle cone posteriorly. Preoperative CT was useful in identifying the posterior portion of the lacerated muscle, enabling successful repair.Keywords: Computed tomography, extraocular muscle, strabismus, strabismus surgery, trauma CASE REPORTA 79-year-old woman suffered left ocular trauma from an umbrella. Her visual acuity was 30/20 and the intraocular pressure was 11 mmHg in the left eye. The bulbar conjunctiva of the left eye was lacerated, and the anterior portion of the lacerated left medial rectus muscle was exposed. There were no pathological findings in the right eye. The patient had remarkable left exotropia, and her left eye could not adduct to the midline. An orbital computed tomography (CT) was performed to locate the extraocular muscle. The orbital CT showed widening of the posterior muscle belly, which suggested that the medial rectus was recessed and that the posterior portion of the medial rectus had slipped posteriorly toward the equator. The CT did not show a blowout fracture or any type of metal in the orbit (Figure 1a). On the same day, the lacerated medial rectus was surgically repaired. We searched for the posterior portion of medial rectus muscle, in keeping with the location of the posterior lacerated portion on preoperative CT. The posterior portion of the medial rectus muscle was successfully located, and both edges of the lacerated medial rectus were sutured together. Postoperatively, the patient's ocular alignment was improved and her left eye was able to adduct beyond the midline. Although slight exotropia remained, she had no diplopia with her face turned to the right. Three months postoperatively, CT showed that the muscle belly of the medial rectus had normalized in width (Figure 1b). Six months after the surgery, the alignment was maintained and the left eye continued to be able to adduct beyond the midline. DISCUSSIONWe have described a successful surgical repair of a traumatic medial rectus laceration with aid of CT. Traumatic medial rectus muscle lacerations are clinically rare. It is difficult to locate a lacerated medial rectus muscle because the medial rectus does not share the common fascia connected with the oblique muscles and because the posterior portion of the Correspondence: Shumpei Obata,

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Section: Discussionmentioning

confidence: 71%

Successful Repair of a Traumatic Medial Rectus Laceration with the Aid of Computed Tomography

Obata

Higashiyama

Nishida

et al. 2015

Neuro-Ophthalmology

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“…There are few reports on the rupture of extraocular muscles [4], [5], [6], [7]. Rupture of the inferior rectus has been reported in three studies [5], [7].…”

Section: Discussionmentioning

confidence: 99%

“…Rupture of the inferior rectus has been reported in three studies [5], [7]. Harish et al reported rupture of the superior oblique [4], while Sari et al reported the rupture of three rectus muscles in blunt trauma [5]. …”

Section: Discussionmentioning

confidence: 99%

Successful repair of injury to the eyelid, lacrimal passage, and extraocular muscle

Shah¹,

Shah²,

Shah³

et al. 2016

GMS Ophthalmology Cases; 6:Doc04

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“…All 6 extraocular muscles might be involved in these conditions. 5 , 23 – 27 However, the most commonly involved muscles are the medial and inferior rectus muscles, as these muscles are nearest to the corneoscleral limbus. In addition, Bell's phenomenon, a protective upward and outward movement of the eye, increases the exposure of these 2 muscles.…”

Section: Discussionmentioning

confidence: 99%

Isolated Total Rupture of Extraocular Muscles

et al. 2015

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Total rupture of extraocular muscles is an infrequent clinical finding. Here we conducted this retrospective study to evaluate their causes of injury, clinical features, imaging, surgical management, and final outcomes in cases of isolated extraocular muscle rupture at a tertiary center in China.Thirty-six patients were identified (24 men and 12 women). Mean age was 34 years (range 2–60). The right eye was involved in 21 patients and the left 1 in 15. A sharp object or metal hook was the cause of this lesion in 16 patients, sinus surgery in 14 patients, traffic accident in 3 patients, orbital surgery in 2 patients, and conjunctive tumor surgery in 1 patient. The most commonly involved muscles were medial (18 patients) and inferior rectus muscles (13 patients). The function of the ruptured muscles revealed a scale of −3 to −4 defect of ocular motility and the amount of deviation in primary position varied from 10 to 140 PD (prism diopter). Computerized tomography (CT) confirmed the presence of ruptured muscles.An end-to-end muscle anastomosis was performed and 3 to 5 mm of muscle was resected in 23 patients. When the posterior border of the injured muscle could not be identified (13 patients), a partial tendon transposition was performed, together with recession of the antagonist in most patients, whereas a recession of the antagonist muscle plus a resection of the involved muscle with or without nasal periosteal fixation was performed in the remaining patients. After an average of 16.42 months of follow-up an excellent result was achieved in 23 patients and results of 13 patients were considered as a failure.In most patients, the posterior border of the ruptured muscle can be identified and an early surgery can be performed to restore function. Alternatively, a partial tendon transposition should be performed. When muscular rupture is suspected, an early orbital CT is required to confirm this possibility, which can then verify the necessity for an early surgical intervention.

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An Unexpected Outcome of Blunt Ocular Trauma: Rupture of Three Muscles

Cited by 14 publications

References 14 publications

Successful Repair of a Traumatic Medial Rectus Laceration with the Aid of Computed Tomography

Successful Repair of a Traumatic Medial Rectus Laceration with the Aid of Computed Tomography

Successful repair of injury to the eyelid, lacrimal passage, and extraocular muscle

Isolated Total Rupture of Extraocular Muscles

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