Exercise rehabilitation for recurrent extraocular muscle movement limitation after pediatric blowout fracture surgery: a case report.

White-eyed blowout fractures with extraocular muscle (EOM) entrapment necessitate emergency surgical intervention. However, even after surgery, diplopia or EOM motion limitations may persist due to the incomplete reduction of soft tissue herniation caused by inadequate dissection or unresolved muscle strangulation. In this report, we present a case of postoperative EOM movement limitation in a 5-year-old girl who experienced recurrent restriction in the upward gaze of her right eye 14 days after surgery. Instead of revision surgery, the patient was treated with targeted EOM exercises focusing on the inferior rectus muscle and inferior oblique muscle. The patient was instructed to slowly move her pupils from the central point to the upper and outer sides, then in a straight line from the central point to the lower and inner sides before returning to the center point. On the 28th postoperative day, 2 weeks after initiating the exercises, the patient's EOM motion fully recovered. This case highlights the effectiveness of EOM exercises as a non-surgical treatment approach for improving recurrent EOM movement limitations in the absence of soft tissue herniation following surgical management of blowout fractures in children.

Smartphone as a tool for evaluating oblique muscle dysfunction / Uso do smartphone como ferramenta para avaliar disfunções de músculos oblíquos

ABSTRACT Purpose: The aim of this study was to describe a simple, accessible, and reliable method using a smartphone for evaluating oblique muscle dysfunctions. Methods: The photograph rotation tool in the iPhone PHOTO app was used by 75 examiners to evaluate 22 photographs from only 9 patients, captured in infra- and supra-dextroversion, and infra- and supra-levoversion, as not all the patients were photographed in the 4 positions mentioned. Each patient received a score for the superior and inferior oblique muscle functions, ranging from -4 (hypofunction) to 4 (hyperfunction) or 0 (normal function), using preediting and postediting photographs. These values were compared with the scores previously given by trained personnel in strabismus screening. The difference in score between the two groups was expressed in natural (whole and non-negative) numbers. The mean and pattern deviation were then calculated. Results: The scores of most of the edited photos showed a lower mean than those of the unedited ones, except for a patient with left superior oblique hyperfunction. The patients with no oblique dysfunction and those with right superior oblique hyperfunction demonstrated (after editing the photograph) scores with greater similarity with their initial scores (p<0.05 and p<0.01, respectively). Similar results were found in the patients with oblique hypofunctions and right inferior oblique hyperfunction (p<0.01). Conclusion: The proposed method for assessing muscular function in vertical strabismus is reproducible, accessible, simple, and reliable, and provides better consistency to the admeasurement.

RESUMO Objetivo: Descrição de um método simples, acessível e confiável para a medida das disfunções dos músculos oblíquos, utilizando-se smartphone. Métodos: Foi utilizado o recurso de rotação de fotografias do aplicativo FOTOS do iPhone®; 75 examinadores avaliaram 22 fotos de 9 pacientes, obtidas em infra e supra dextroversão, infra e supra levoversão (nem todos os pacientes foram fotografados nas 4 posições citadas). Conferiu-se aos pacientes uma pontuação para a função do músculo oblíquo superior e músculo oblíquo inferior, que variou de -4 (negativo para hipofunção) a +4 (positivo para hiperfunção), ou 0 (normofuncionantes), antes e depois da edição das fotografias. Esses valores foram comparados à avaliação prévia atribuída pelos assistentes do estrabismo. Computou-se a diferença da pontuação entre eles em números naturais (inteiros e não negativos); foram calculadas média e desvio padrão dessas medidas. Resultado: A medida da maioria das fotos editadas apresentou média inferior as não editadas, à exceção de um paciente com hiperfunção de oblíquo superior esquerdo. Pacientes sem disfunção de oblíquos demonstraram, após edição das fotos, maior similaridade com o valor inicialmente determinado (p<0,05), assim como os pacientes com oblíquo superior direito hiperfuncionantes (p<0,01). Os mesmos resultados são encontrados nos pacientes com hipofunção dos oblíquos e hiperfunção de oblíquo inferior direito (p<0,01). Conclusão: O método utilizado para medida das funções musculares nos estrabismos verticais é reprodutível, acessível, simples, confiável, e confere maior uniformidade à aferição.

Superior oblique myositis mimics a subperiosteal abscess in a patient with sinusitis / Miosite oblíqua superior mimetiza abscesso subperiosteal em paciente com sinusite

ABSTRACT Isolated superior oblique myositis is a rare variant of idiopathic orbital myositis. We are reporting for the first time the case of a 19-year-old woman who had isolated superior oblique myositis with sinusitis that mimics a subperiosteal abscess. Despite the typical history of upper respiratory tract infection and laboratory test results and initial radiological findings suggestive of orbital cellulitis secondary to sinusitis, the initial response to systemic steroid with subsequent imaging changes and the relapse after cessation of steroid therapy helped us reach the diagnosis.

RESUMO A miosite oblíqua superior isolada é uma variante muito rara da miosite orbital idiopática. Trata-se do primeiro relato de uma mulher de 19 anos como um caso de miosite oblíqua superior isolada com sinusite que mimetiza abscesso subperiosteal. Apesar da história típica de infecção do trato respiratório superior, exames laboratoriais e achados radiológicos iniciais sugestivos de celulite orbital secundária à sinusite, a resposta inicial ao esteróide sistêmico com subsequentes alterações de imagem e recaída, após a cessação do esteróide, nos ajudou a alcançar o diagnóstico.

Horizontal Extraocular Muscle and Scleral Anatomy in Children: A Swept-Source Anterior Segment Optical Coherence Tomography Study.

PURPOSE: To evaluate the efficacy of anterior segment swept-source optical coherence tomography (SS-OCT) for examining horizontal extraocular muscle thickness, distance from the corneal limbus to the insertion of the horizontal extraocular muscle (limbus to insertion distance), and scleral thickness in Korean pediatric strabismus patients. METHODS: This study included pediatric strabismus patients between 5 and 10 years of age. Children with any ocular disease other than strabismus or a history of ocular surgery were excluded. SS-OCT was used to measure horizontal extraocular muscle thickness, limbus to insertion distance, and scleral thickness. Eyes were classified into subgroups by sex, spherical equivalent of the refractive error (measured with cycloplegic refraction), and fixating/deviating eye. RESULTS: One patient initially included in this study was excluded due to poor cooperation. Of the remaining 35 eyes of 20 patients, 19 eyes (54.3%) were from male patients and 16 eyes (45.7%) were from female patients. The mean patient age was 7.86 ± 1.38 years. Lateral scleral thickness was greater in male eyes than in female eyes (p = 0.048). No other differences were noted between male and female children. Additionally, there were no statistically significant differences between fixating and deviating eyes or among spherical equivalent groups for any parameter examined. CONCLUSIONS: Anterior segment SS-OCT can successfully and comfortably measure horizontal extraocular muscle and scleral anatomy in children. These measurements may be helpful for treatment and follow-up of pediatric strabismus patients.

Horizontal Extraocular Muscle and Scleral Anatomy in Children: A Swept-Source Anterior Segment Optical Coherence Tomography Study

PURPOSE: To evaluate the efficacy of anterior segment swept-source optical coherence tomography (SS-OCT) for examining horizontal extraocular muscle thickness, distance from the corneal limbus to the insertion of the horizontal extraocular muscle (limbus to insertion distance), and scleral thickness in Korean pediatric strabismus patients. METHODS: This study included pediatric strabismus patients between 5 and 10 years of age. Children with any ocular disease other than strabismus or a history of ocular surgery were excluded. SS-OCT was used to measure horizontal extraocular muscle thickness, limbus to insertion distance, and scleral thickness. Eyes were classified into subgroups by sex, spherical equivalent of the refractive error (measured with cycloplegic refraction), and fixating/deviating eye. RESULTS: One patient initially included in this study was excluded due to poor cooperation. Of the remaining 35 eyes of 20 patients, 19 eyes (54.3%) were from male patients and 16 eyes (45.7%) were from female patients. The mean patient age was 7.86 ± 1.38 years. Lateral scleral thickness was greater in male eyes than in female eyes (p = 0.048). No other differences were noted between male and female children. Additionally, there were no statistically significant differences between fixating and deviating eyes or among spherical equivalent groups for any parameter examined. CONCLUSIONS: Anterior segment SS-OCT can successfully and comfortably measure horizontal extraocular muscle and scleral anatomy in children. These measurements may be helpful for treatment and follow-up of pediatric strabismus patients.