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F. Lam, C.R. Weir, M. Cleary; Binocular Outcomes Following Severe Trauma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3138.
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Monocular visual results following severe ocular trauma are well described. Prognostic factors include visual acuity at the time of presentation, the size of laceration, damage to lens and posterior segment involvement. However, little is known about the effect of such injuries on binocular visual outcomes. We therefore report the retrospective findings from 6 patients who developed diplopia following such trauma.
A retrospective analysis of the patients presenting to the orthoptic and ophthalmic clinics at Gartnavel General Hospital between 1999 & 2005 with binocular problems as a result of ocular trauma was undertaken. During follow up visits, near & distance visual acuities, ocular examination findings, cover tests, prism cover tests, ocular motility, motor & sensory fusion, stereoacuities and fields of binocular single vision were recorded.
All 6 patients were male (range 16–29yrs; average 24; median 26). 5 injuries were penetrating (3 with intraocular foreign bodies) and 1 was from blunt trauma. At the time of presentation visual acuities in the affected eye ranged from 6/60 to perception of light. All patients required at least 1 vitreo–retinal surgical procedure. The mean number of subsequent surgical procedures was 3 (range 2 to 4). All patients required at least 1 vitreo–retinal surgical procedure. Follow–up was 3 to 4.5 years. At the most recent clinic visit 2 patients were aphakic (VA 6/5, 6/9 with CL) and 3 were pseudophakic (VA 6/6, 6/36 and HM). The 6th patient’s was still phakic with an acuity of 6/12. All patients developed a secondary exotropia. 3 patients showed binocular potential of whom 2 were successfully treated with botulinum toxin to the lateral rectus muscle of the affected eye, whilst the 3rd required prims initially. Of the remaining 3 patients, 1 patient is now suppressing and the other has intractable diplopia despite of good visual acuities in both patients, whilst the third patient has intractable diplopia despite a poor visual acuity.
Whilst patients sustaining serious eye injuries may regain surprisingly good monocular visual acuity, the effect of severe ocular trauma on binocular vision should not be underestimated. The disruption of binocularity in these patients is often multi–factorial and due to both motor and sensory factors resulting from the original injury and subsequent surgical procedures with a prolonged visual recovery. This study illustrates that a good monocular visual outcome does not necessarily mean a good binocular outcome, and that a poor visual outcome does not prevent severe binocular symptoms.
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