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S. A. Newman; Interventional Repair of Lacerated Extra Ocular Muscles. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3011.
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Laceration of extra ocular muscles are a rare complication of trauma. With the advent of endoscopic sinus surgery some of these may be iatrogenic. When the extra ocular muscle is avulsed posterior to the tenon’s capsule a combination of lost muscle, limited potential motility, and scarring may limit recovery. Exploration of the orbit, repair of the lacerated muscle, and subsequent additional muscle surgery on the contralateral eye may maximize binocularity in these patients and lead to good functional outcome.
A retrospective case series of 3 patients suffering avulsed extra ocular muscles were reviewed for the diagnosis, clinical approach, and results. Two of these patients had avulsion of the extra ocular muscles related to endoscopic sinus surgery, one for a mucocele and the second during revision of a dacryocystorhinostomy. A third patient had laceration of the medial rectus muscle due to a fall.
Age ranged from 21 to 87. All three were women. All three patients underwent orbital exploration with identification of the proximal end of the lacerated medial rectus muscle with primary repair. One patient had adequate binocularity as identified by BSV and Hess screen to avoid additional surgery. The two other patients were treated with contralateral surgery, in one case simple recessions, and in another case recession and Faden procedure.
Orbital exploration following traumatic injury of extra ocular muscles often permits a primary repair. Despite repair, there is commonly residual limitation of movement of the involved eye. The use of the Hess screen and binocular single vision fields allows planning of additional surgery to maximize binocularity. The Faden procedure may be particularly helpful.
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