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.

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.

Changes in intraocular pressure associated with the administration of propofol.

The effect of propofol on intraocular pressure (IOP) was measured in 25 patients presenting for elective non-ophthalmological surgery when propofol was used for the induction and maintenance of anaesthesia (together with 67% nitrous oxide in oxygen, and vecuronium). Normocapnia was maintained. After induction of anaesthesia, intraocular pressure was significantly lower than the baseline value; during maintenance IOP never exceeded the preinduction value.