Traumatic Ocular Motility Impairment and Orbital Fracture

Objectives: To summarize the clinical features and treatment strategies of traumatic diplopia and ocular motility impairment, by which to enhance the understanding and avoid misdiagnosis on such cases.
Method: A total of 170 cases suffering difficulties in daily life induced by post-traumatic diplopia, ocular motility impairment were documented. All patients underwent orbital auscultation, forced reduction test, and 3D-CT examination. The visual acuity, diplopia, and ocular motility were documented before operation, and 1-6 month after operation. In patients with forced reduction test positive, the location and area of fracture and the condition of muscle entrapment were evaluated by 3D-CT examination. 169 patients have traumatic ocular motility impairment concomitant with orbital fracture. Two patients have vascular murmur as identified by orbital auscultation, and diagnosed as internal carotid sinus fistula with CTA examination. These two patients were accepted intra-arterial treatment. One of these two patients was without orbital fracture. The post-operative follow-up was 3-6 month (Average 2.5 month).
Results: The function of extra-ocular muscle of all patients recovered within 3 months as evident by the disappearing of ocular motility impairment, except that one case which underwent operation at post-traumatic 3 month has tissue adhesion and partial extra-ocular muscle paralysis.
Conclusions: Post-traumatic ocular motility impairment is a major complication of orbital fracture. The crucial steps in orbital fracture treatment are early diagnosis, timely treatment, thorough removing of bone fragments, releasing entrapped intra-orbital tissue, and orbital reconstruction. Pre-operative forced reduction test positiveness is an important operation indication. Forced reduction test, orbital 3D-CT reconstruction can facilitate the diagnosis and provide information for establishment of therapy strategy, and should be regarded as routine examinations. The co-existence of traumatic ocular motility impairment, orbital or cranial base fracture, and internal carotid sinus fistula is very rare in clinical practice. Traumatic non-restrictive ocular motility impairment with intact ocular structure can be misdiagnosed as cranial nerve paralysis. Orbital auscultation is useful to avoid misdiagnosis in such cases and should be regarded as routine examination. Attention should be paid on the post-operative positive or forced extra-ocular muscle exercises, application of neuro-protection drugs, the effectiveness of which have been verified in our clinical practice.