A protocol for extraocular muscle surgery after orbital floor fracture ("blow-out").

Purpose: If, after primary repair of an orbital fracture by maxillo-facial surgeons, diplopia persists, extraocular muscle surgery may be necessary. It was the purpose of this study to examine proposed surgical treatment in these cases to determine their efficacy.

Subjects And Methods: We analyzed, retrospectively, the files of 14 patients who were treated in our strabismological department for persistent diplopia caused by injury to the extraocular muscles and/or to the surrounding structures.

Examination, registration and analysis of clinical expressions of DVD.

The clinical appearance of dissociated vertical deviation (DVD) can be modified by the presence of other vertical deviations. This may be one of the reasons of relatively late diagnosis (sometimes even only after a first strabismus operation). If the DVD is not recognized preoperatively, this can lead to unexpected failure of the strabismus operation, with cosmetically unacceptable vertical deviations.

Surgery on the extra-ocular muscles after orbital fracture.

We analyzed the files of 61 patients presenting with diplopia due to orbital fractures. Thirty-four patients needed a primary orbital reconstruction and this diminished the complaints of diplopia in most cases. In only 5 cases additional ocular surgery on the extra-ocular muscles was indicated.

Primary exodeviations. Surgical results of 94 patients operated since 1983.

Surgical results of 94 patients with primary exodeviation operated since 1983 are presented. Seventy-five patients where treated bilateral rectus externus muscle recession and 19 patients with recession of rectus externus combined with resection of rectus internus muscle. Both techniques have equal results.

Basic principles for strabismus reinterventions.

Fibro-elastic and mechanical factors are more important in reinterventions than in traditional strabismus surgery. It is imperative to detect them preoperatively and intraoperatively. For this purpose, the patient's personal history and complaints are analysed and some specific examination techniques are discussed such as the intraoperative eye position, the forced duction test, the muscle elasticity test and the spring back test.

Postoperative diplopia, also in children.

Permanent diplopia caused by strabismus surgery can also occur in children. In certain cases we see an analogy with the feared and well known persistent diplopia that can occur after anti-suppressive therapy. This article discusses some of these cases and their treatment.

Results of transantral decompression in hyperthyroid exophthalmos.

For the moment, transantral orbital decompression is the best procedure for the treatment of manifest exophthalmos because it is a simple and effective method with hardly any postoperative complications. If some ocular motility disturbances do not disappear spontaneously postoperatively, they can be treated successfully by muscle surgery. We found that the postoperative reduction of exophthalmos further improved during the first year with an average of 3 mm.