Complex Ocular Motor Disorders in Children

Brodsky, Michael C.

doi:10.1007/978-0-387-69069-8_7

Cited by 6 publications

(4 citation statements)

References 692 publications

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“…Of note, a positive forced traction test during the acute phase of injury may be derived from hemorrhage and/or edema within and around the fibrous septae which attach both the inferior rectus and inferior oblique muscles to the periorbita. 46 Although a forced duction test is performed, the acute phase of trauma (edema, hemorrhage) may also prevent the reliable differentiation of eye mechanical restriction from oculomotor nerve palsy (inferior division to the inferior oblique muscle). 46 Consequently, notwithstanding the forced duction test, orbital pain during various ductions, and CT scan may all contribute to accurate diagnosis, none of them achieves 100% sensitivity or specificity.…”

Section: Discussionmentioning

confidence: 99%

“…46 Although a forced duction test is performed, the acute phase of trauma (edema, hemorrhage) may also prevent the reliable differentiation of eye mechanical restriction from oculomotor nerve palsy (inferior division to the inferior oblique muscle). 46 Consequently, notwithstanding the forced duction test, orbital pain during various ductions, and CT scan may all contribute to accurate diagnosis, none of them achieves 100% sensitivity or specificity. 47 On surgical exploration of the orbital floor, it is crucial for surgeons to ascertain the more posterior border of the fracture line.…”

Section: Discussionmentioning

confidence: 99%

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Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Papadiochos

Petsinis

Tasoulas³

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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Orbital trapdoor fractures (OTFs) entail entrapment of intraorbital soft tissues with minimal or no displacement of the affected bones and are almost exclusively seen in children. This article aimed to report the diagnosis and treatment of an OTF of the floor in an adult patient and to critically review the literature regarding the management aspects of this specific subset of orbital blowout fractures in adults. A 29-year-old man presented with limitations of vertical right eye movements owing to blunt orbital trauma. The patient mainly complained of double vision in upper gazes and some episodes of nausea. Neither floor defect nor significant bone displacement found on orbital computed tomography, while edema of inferior rectus muscle was apparent. The patient underwent surgical repair 5 days later; a linear minimally displaced fracture of the floor was recognized and complete release of the entrapped perimuscular tissues was followed. Within the first week postoperatively, full range of ocular motility was restored, without residual diplopia. This case was the only identified pure OTF over a 6-year period in our department (0.6% of 159 orbital fractures in patients >18 years). By reviewing the literature indexed in PubMed, a very limited number of either of isolated case reports or retrospective case series of pure OTFs has been reported in adults. Contrary to the typical white-eyed blowout fractures, the literature indicates that OTFs in adults seem to not always constitute absolute emergency conditions. Although such fractures need to be emergently/ immediately treated in children, in the absence of true muscle incarceration, adults may undergo successful treatment within a wider but either early or urgent frame of time. Adults frequently exhibit vagal manifestations and marked signs of local soft tissues injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Papadiochos

Petsinis

Tasoulas³

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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“…[4] It is considered to be protective, as the risk of exposure keratitis is reduced in the presence of positive Bell's phenomenon, whereas in patients with poor Bell's phenomenon, chances of serious corneal exposure leading to dryness and ulceration are high if lagophthalmos ensues following lid surgery. [5]…”

Section: Discussionmentioning

confidence: 99%

“…[6] In patients with poor Bell's phenomenon, ptosis correction should be approached with caution as it may lead to serious corneal complications due to exposure. [4] Correction of ptosis in patients with CPEO, third cranial nerve palsy, and OMG with the limitation of extraocular movements and poor Bell's phenomenon is fraught with that risk. In fact, many still believe that any surgical intervention is contraindicated in these groups of patients as postoperative lagophthalmos would subject them to an unacceptably high risk of developing exposure keratopathy.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of frontalis suspension with silicone rods in ptosis patients with poor Bell's phenomenon

Shah

Mukherjee

2017

Taiwan J Ophthalmol

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PURPOSE:The purpose of the study was to evaluate the efficacy of silicone rods as frontalis sling for correction of ptosis associated with poor Bell's phenomenon in specific situations.MATERIALS AND METHODS:A retrospective interventional case series of 25 eyes of 19 patients who underwent frontalis suspension surgery with silicone rods for ptosis correction from May 2006 to April 2011, was performed. Inclusion criteria included severe ptosis with poor Bell's phenomenon. Patient evaluation included clinical history and other relevant parameters of ptosis measurement. Final outcome measurements included postoperative lid height, lagophthalmos, complications, need for reoperation, and patient satisfaction.RESULTS:Mean age at presentation was 25.72 ± 2.2 years. The sex ratio of male: female was 1.11. The causes of ptosis included chronic progressive external ophthalmoplegia (CPEO) in 11 eyes (44%), oculopharyngeal dystrophy in 2 (8%), third cranial nerve palsy in 7 (28%), traumatic in three eyes (12%), and iatrogenic postoperative ptosis (after orbital tumor excision) in two eyes (8%). The postoperative palpebral fissure height and margin reflex distance improved significantly (P = 0.0001). Extrusion of the sling and granuloma formation occurred in two eyes each, and these patients had to undergo sling removal. One patient developed mild exposure keratopathy and was managed conservatively.CONCLUSION:Silicone is an effective material for use in frontalis suspension in the management of severe ptosis with poor Bell's phenomenon. The elastic nature of silicone rod makes it an ideal suspensory material for patients with CPEO or third nerve palsy.

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Disorders of Supranuclear Control of Ocular Motility

Lavin¹,

Donahue²

2009

Ophthalmology

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Complex Ocular Motor Disorders in Children

Cited by 6 publications

References 692 publications

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Efficacy of frontalis suspension with silicone rods in ptosis patients with poor Bell's phenomenon

Disorders of Supranuclear Control of Ocular Motility

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