Management of diplopia in patients with blowout fractures

Abstract

Purpose:To report the management outcomes of diplopia in patients with blowout fracture.Materials and Methods:Data for 39 patients with diplopia due to orbital blowout fracture were analyzed retrospectively. The inferior wall alone was involved in 22 (56.4%) patients, medial wall alone was involved in 14 (35.8%) patients, and the medial and inferior walls were involved in three (7.6%) patients. Each fracture was reconstructed with a Medpore® implant. Strabismus surgery or prism correction was performed in required patients for the management of persistent diplopia. Mean postoperative follow up was 6.5 months.Results:Twenty-three (58.9%) patients with diplopia underwent surgical repair of blowout fracture. Diplopia was eliminated in 17 (73.9%) patients following orbital wall surgery. Of the 23 patients, three (7.6%) patients required prism glasses and another three (7.6%) patients required strabismus surgery for persistent diplopia. In four (10.2%) patients, strabismus surgery was performed without fracture repair. Twelve patients (30.7%) with negative forced duction test results were followed up without surgery.Conclusions:In our study, diplopia resolved in 30.7% of patients without surgery and 69.2% of patients with diplopia required surgical intervention. Primary gaze diplopia was eliminated in 73.9% of patients through orbital wall repair. The most frequently employed secondary surgery was adjustable inferior rectus recession and <17.8% of patients required additional strabismus surgery.

Quand demander un examen orthoptique dans la prise en charge des fractures du plancher de l’orbite ?

“…De nombreuses études évaluent la diplopie chez des patients opérés. Le plus souvent celle-ci n'est évaluée qu'en postopé-ratoire [3,6,7,[11][12][13][14][15]. La revue de la littérature retrouve un taux de diplopie qui varie de 1,2 à 32,1 % selon les équipes [14].…”

“…À 2 mois postopératoire, aucun patient opéré ne présentait de diplopie clinique ; un seul présentait un examen coordimétrique légèrement altéré mais normalisé à 3 mois. La comparaison de ces résultats avec la littérature est très difficile en raison des différents protocoles utilisés car les auteurs ne réalisent pas de test coodimétrique de façon systématique [3,6,7,[11][12][13][14][15][16]. Pour les patients non opérés, nous observons que 1 mois après la fracture, il n'existe plus de diplopie et d'anomalie coordimé-trique (sauf 1 cas) et le résultat est jugé satisfaisant.…”

“…Pour les patients non opérés, nous observons que 1 mois après la fracture, il n'existe plus de diplopie et d'anomalie coordimé-trique (sauf 1 cas) et le résultat est jugé satisfaisant. Ceylan retrouve 2,5 % de diplopie résiduelle nécessitant l'utilisation de prismes sur une série de 20 patients non opérés, ce qui est comparable à notre étude [15]. Les non-indications opératoires sont définies par Jank : absence d'incarcération tissulaire dans la fracture, absence d'effondrement important du plancher, absence de troubles de la motilité ou de diplopie [17].…”

Prism use in adult diplopia

“…The reported incidence of diplopia following blowout fractures varies from 57 to 86% [10,11]. In a review of diplopic cases, 63-74% of patients had elimination of the diplopia with orbital fracture repair [10,12]. In another study, diplopia was eliminated in 89% of patients with orbital fracture repair alone [13].…”

Binocular Diplopia Treated with Inferior Rectus Recession and Faden Operation of The Normal Eye in a Case of Blow Out Fracture

“…2 Diplopia caused by blowout fracture can be managed by medical treatment, botulinum toxin injection, orbital wall repair, prisms and strabismus surgery. 3 Patients who have diplopia due to slight motility disorders can be made symptom free with prisms. Patients who have an angle of deviation greater than 6Δ usually complain of diplopia which is compensated by an abnormal head posture, and require surgical intervention.…”