Medial Rectus Incarceration Following Isolated Medial Orbital Wall Fractures

Abstract

Purpose:: This retrospective review evaluates the largest collection of cases of isolated medial orbital wall fractures with medial rectus incarceration.

Methods:: Retrospective chart review and literature review. All patients who had suffered an isolated medial orbital wall fracture with clinical and CT evidence of medial rectus incarceration were included. Charts, orbital computed tomography (CT) imaging, and clinical photos were used. Ocular motility limitation was graded on a scale of 0 to -4, where 0 equals no limitation (normal) and -4 equals no movement in the field of gaze. Hertel exophthalmometry was used to measure enophthalmos. Exclusion criteria included the presence of coexisting orbital floor or facial fractures. Age, gender, side, mechanism of injury, ocular motility, associated trauma, time to surgery, postoperative ocular motility, length of follow-up and postoperative exophthalmometer measurements were recorded. Postoperative diplopia in primary or other gaze positions and any other complications were also noted.

Results:: Eleven cases of isolated medial wall fracture with medial rectus incarceration are presented. Adduction and abduction deficits were common in all patients and 82% (9 of 11) presented with abnormalities in both. The mean adduction deficit was -2.9 and the mean abduction deficit was -1.7. In 64% (7 of 11) the adduction deficit was more pronounced than the abduction deficit and in 27% (3 of 11) adduction and abduction deficits were equal. One patient had normal to supra normal abduction and -4 limitation of adduction and one patient had an abduction deficit with normal adduction. Twenty-seven percent (3 of 11) had an associated exotropia in primary gaze and one patient had globe retraction upon attempted abduction.

Conclusions:: Isolated medial orbital wall fractures with medial rectus incarceration are quite rare and this is the largest collection of these cases. Combined adduction and abduction deficits were common in most patients and ocular motility deficits were greater in adduction than abduction. Surgery is recommended for these patients as soon as possible to minimize long-term morbidity. Extraocular motility improved in all patients who underwent surgery and mean post-operative enophthalmos was minimal despite relatively large fractures.

Keywords: eye movements • orbit • trauma