Diplopia and Strabismus in Orbital Blowout Fractures

Abstract

Diplopia and restriction of ocular movements are common sequelae of orbital blowout fractures. The initial evaluation of diplopia with careful follow-up of these patients can be useful in the decision making process as to when or if to institute surgical intervention. Many patients have a complete resolution of diplopia and strabismus without surgical intervention. A review of the surgical experience at the University of Wisconsin over a 23-month period revealed that most patients had multiple system trauma including the orbit and were initially treated by non-ophthalmic specialists. Motor vehicle accidents, sports and fighting were responsible for 75% of the injuries. In two cases, both female, physical abuse was implicated.

Two of twenty-one patients suffered severe facial trauma and had no light perception in the injured eye. Fifteen of the remaining 19 (78%) complained of diplopia. Restriction of ocular movement, most commonly to elevation, was present in all of these patients.

Surgical intervention occurred, on average, eleven days after the injury and diplopia was improved in all but three cases five months after injury. Two cases (9.5%) had persistent diplopia and required strabismus surgery after repair of the orbital fracture. One patient was corrected with prisms alone.

• orbital blowout fracture
• diplopia
• strabismus