ABSTRACT
The decision to use surgical or nonsurgical treatment for orbital blow-out fractures is still controversial. Previously, it was advocated that all blow-out fractures should be treated surgically based on the conception that extraocular muscles were blown out and trapped in the fracture area. However, a shift to a more conservative approach occurred gradually, most likely due to the evidence of spontaneous improvement. The medical records of two patients who were diagnosed as having an isolated medial wall fracture with medial rectus muscle displacement into the ethmoid sinus, as demonstrated by computed tomography, were reviewed. Both patients showed improvement only with conservative therapy.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Orbital Fractures/drug therapy , Administration, Oral , Adolescent , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Child , Decision Making , Diplopia/diagnosis , Diplopia/drug therapy , Diplopia/etiology , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Orbital Fractures/diagnostic imaging , Orbital Fractures/etiology , Tomography, X-Ray Computed , Trauma Severity IndicesABSTRACT
Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14-45 years) were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD) (interquartile range [IQR] 57.5-70) and vertical deviation was 13.5 PD (IQR 10-20). The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1-16), and the vertical deviation was 0 PD (IQR 0-4). The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10-16). All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation. Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy.
ABSTRACT
We report a 28-year-old man with non-Hodgkin's lymphoma who presented with acute onset of diplopia 3 weeks after the completion of combination chemotherapy with vincristine. He had a left esotropia with marked decrease in abduction. Magnetic resonance imaging scan of the brain showed thickening and enhancement of the left abducens nerve. Lymphomatous and other intracranial pathologies were excluded, and vincristine neurotoxicity was considered as the possible etiology of the abducens nerve palsy. His diplopia improved gradually, then completely resolved 4 weeks after the cessation of vincristine therapy. We concluded that isolated ocular muscle paresis can be the presenting sing of a toxic neuropathy associated with vincristine use.