|
| |
| LETTER TO THE EDITOR |
|
| Ahead of print publication |
|
|
Diplopia in blow-out fractures
Osman M Ceylan, Yusuf Uysal, Fatih Mehmet Mutlu, Kemal Tuncer, Halil Ibrahim Altinsoy
Department of Ophthalmology, Gulhane Military Medicine Academy, Ankara, Turkey
Correspondence Address:
Osman M Ceylan,
Department of Ophthalmology, Gulhane Military Medicine Academy, 06018, Ankara
Turkey
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/0301-4738.100000
Dear Editor,
We thank the authors for their interest in our article. [1] We did not apply any quantative value for binocular single-visual fields or Hess screens, even though it was described in literature. [2],[3] In the study, 23 patients with diplopia underwent surgical repair of blow-out fracture. Of the 23 patients, six patients were treated additionally with strabismus surgery or prisms for residual diplopia. Persistent diplopia was less than initial diplopia measured prior to orbital wall repair. Even though there was an improvement in the diplopia after orbital wall repair, it was a clinically significant complaint of the patients. The mean time between trauma and orbital wall repair was reported as 8.4 days (range, 2-20 days) in the manuscript. The mean time between trauma and strabismus surgery was also reported as 10.5 months (range, 3-28 months). We waited for at least 3 months for strabismus surgery after orbital wall reconstruction.
As the authors mentioned in the letter, inferior rectus recession was the main surgery due to hypotropia. However, esotropia in one case due to medial wall fracture and in one case with orthotropia in primary position but limitation and diplopia in upgaze were seen. The patient with limitation and diplopia in upgaze was treated with a Faden suture to the superior rectus of the unaffected eye to improve binocular single-visual field. There was diplopia in two cases in downward gaze above 20 degrees. The authors suggest performing multipositional magnetic resonance imaging (MRI) [4] in patients to determine the cause for the residual diplopia in postorbital wall repair. Our study is retrospective and no multipositional MRI was ordered for cases with residual diplopia. Although there may be various benefits of multipositional high-resolution MRI to find out the cause for the residual diplopia in postorbital wall repair, improvements in clinical findings, diplopia and decrease of patients' complaints can give some clues to the clinician.
| References | |  |
| 1. | Ceylan OM, Uysal Y, Mutlu FM, Tuncer K, Altinsoy HI. Management of diplopia in patients with blowout fractures. Indian J Ophthalmol 2011;59:461-4.  [ PUBMED]  |
| 2. | Furuta M, Yago K, Iida T. Correlation between ocular motility and evaluation of computed tomography in orbital blowout fracture. Am J Ophthalmol 2006;142:1019-25. [ PUBMED] |
| 3. | Folkestad L, Lindgren G, Möller C, Granström G. Diplopia in orbital fractures: A simple method to evaluate eye motility. Acta Otolaryngol 2007;127:156-66. |
| 4. | Laursen J, Demer JL.Traumatic longitudinal splitting of the inferior rectus muscle. J AAPOS 2011;15:190-2. [ PUBMED] |
|
.png "Santen")
