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Strabismus Secondary to Blowout Fracture

Correspondence: Requests for reprints should be addressed to: Dr. Joseph L. Demer, Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 90024-7002 e-mail jld{at}ucla.edu

Blowout is a form of orbital fracture due to stress on the orbital rim during elevation of intraorbital pressure. Like related orbital wall fractures, blowout may be associated with paralytic strabismus caused by traumatic myopathy or cranial nerve palsy, restrictive strabismus due to entrapment of extraocular muscles (EOMs) or orbital connective tissues, or dystopic strabismus resulting from globe displacement. In addition to clinical examination, forced duction, force generation testing, and orbital imaging may be diagnostically useful to ascertain the remaining structure and function of traumatized EOMs. Appropriate management of strabismus associated with orbital wall fractures requires ascertainment of the mechanism of the motility disturbance, with therapy targeted to reverse the specific lesion where possible. Repair of the fracture itself is generally not necessary and can even be associated with greater strabismus. An individually tailored plan of surgical management is helpful to maximize the extent of binocular vision following blowout fracture.

Key words: orbital fracture, restrictive strabismus, muscle paresis, trauma