Management of strabismus due to orbital wall fractures

3 April 2023 | Fiona Rowe (Prof) | Paediatric Ophthalmology / Strabismus

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The authors present a retrospective single centre review of patients with strabismus due to orbital wall fractures with regard to their clinical presentation and outcomes. The study included 347 patients; 87% male and mean age of 32.42 ±12.9 years. Ten percent underwent extra-ocular muscle surgery; 34 patients had 40 surgeries. Overall, fractures were single wall for 131 patients, two walls for 107 and three or more walls for 109 patients. The floor was involved in 251 and medial wall in 154. Orbital fracture repair was undertaken for 92. The most common strabismus type was exotropia (n=89) and hypotropia (n=68). Strabismus surgery groups were 14 restrictive, 12 paralytic and eight mixed. Mean horizontal angle was 35.81 ±16.89PD and mean vertical angle was 16.08 ±13.45PD. Preoperative diplopia was reported for 27. Ocular motility limitations included limited elevation (n=19), depression (n=17) and adduction (n=15). Postoperative mean horizontal angle was 18.34 ±10.97PD and for vertical angle was 9.59 ±7.02PD. Persistent diplopia occurred for six patients requiring prisms. Overall, a successful outcome was achieved in 41%. Limitations of this study were its retrospective nature. The authors conclude that management of strabismus is complex and unpredictable in orbital fractures, requiring individualised tailored management.