Current Management of Late Posttraumatic Enophthalmos | Journal CME Article-Journal CME Article: Current Management of Late Posttraumatic Enophthalmos Video 7

Video Transcription

This video will review how to incorporate the eye findings of a patient with enophthalmos into their management.  The surgeon must always have a good understanding of how diplopia affects the patient in their daily lives.  It must be remembered that the globe position affects the mobility, and that entrapment or distortion of orbital tissues and their attachments affects how the eye moves and  contributes to diplopia. This diagram reminds us that the suspensory tissues about the globe play an important role in its movement and result in diplopia.  It's critical that the geometric center of the globe is in the correct position following treatment.  The first case is that of a gentleman with a left orbital floor and lateral rim fracture. His major issue was significant diplopia on down gaze.  He as well had an exciclotorsion of approximately 8 to 10 degrees. Looking at his eye movements, we can see that in primary position he had a left hypertropia  or higher eye of approximately 6 prism diopters. This increased greatly when he tried to look downwards where the eye would not depress  adequately and increased to 30 prism diopters. He was not able to elevate the eye properly, leaving him with a hypotropia of 5 prism diopters in up gaze.  The binocular visual field demonstrates a constricted visual field with significant diplopia on up and down gaze as well as on right gaze.  Post-operatively, his diplopia was much improved with some bothersome diplopia remaining only  on more extreme down gaze, but straight ahead in primary position he was very, very good. His torsion had improved from 10 degrees down to approximately 4 degrees and was no longer  bothersome. His binocular visual field shows that for approximately 15 to 20 degrees in up gaze, down gaze and closer to 30 to 40 degrees along the horizon he had single vision.  This was far improved from his initial situation. Outcome measures include most importantly the change in diplopia and how well the patient  is able to function along with the limitations of movement. If diplopia remains significant, there is a consideration for possible additional treatments.

Video Summary

The video reviews managing enophthalmos with a focus on diplopia's impact on daily life. It highlights how globe position and orbital tissue distortion affect eye movement and diplopia. A case study discusses a patient with fractures leading to significant diplopia, which worsened on down gaze and affected visual fields. Post-operative results showed improved diplopia and torsion, enhancing the patient’s single vision across various gaze ranges. The primary outcome measures are changes in diplopia and functional limitations, with potential for further treatment if significant diplopia persists.

Keywords

enophthalmos

diplopia

orbital fractures

eye movement

post-operative outcomes