Surgical Management of Strabismus in Patients With Orbital Fracture

Purpose: Till date, the surgical policy of strabismus in patients with orbital fracture is scarcely described in literature. The purpose of this study was to describe the clinical features and surgical experience in patients with strabismus and persistent diplopia after orbital fracture repair, or in patients who need not receive surgery for orbital fracture. Patients and Methods: Retrospective review was performed on patients with orbital fracture who received strabismus surgery between 2004 and 2016 in Eye Hospital, Zhongshan Ophthalimc Center, Sun Yat-sen University, China. The following clinical data were recorded from the patients' charts: the nature of fracture, age at surgery, preoperative motor alignment, stereoacuity, surgical methods, surgical outcomes, and complications. Deviations of 10 prism diopter (PD) or less of horizontal angle and deviation of 5 PD or less of vertical angle in the primary position were considered to be a successful outcome. Results: A total of 29 patients (23 males and 6 females) with an average age of 32.4 +/- 16.6 years (2-61 years) were recruited in this study. The strabismus was paralytic in 16 patients, restrictive in 2 patients, and both paralytic and restrictive in 11 patients. The surgical methods were quite various in each patient; however, all patients underwent either rectus recession or rectus recession plus resection. With at least 6 months of follow-up, preoperative horizontal deviation of 32.79 +/- 22.84 PD was reduced to 6.69 +/- 13.01 PD (P < 0.01). The vertical deviation was reduced from 22.76 +/- 17.66 PD to 6.59 +/- 7.98 PD (P < 0.01). Sixteen patients (55.2%) were considered as success, whereas a surgical undercorrection was observed in 44.8%. There were no surgical complications. Conclusions: The clinical manifestations of strabismus in patients with orbital fracture or after fracture repair are quite complex, often involving both paralytic and restrictive factors. The surgical treatment of each patient needs to be individualized. The rectus muscle recession and resection seems to be predictable, effective, and stable.