PMC3607413_01
Computed tomography (CT) images of the orbits from Case 1. (A) Axial and (B) coronal CT images show bony dehiscence in the medial wall of the left orbit (arrows).. Notes: There is soft tissue thickening at the left orbital apex (arrowhead in A) and loss of normal fat planes around the medial and inferior rectus muscles (arrowheads in B). These findings are consistent with penetration into the left orbit and soft tissue injury (transection of the medial rectus muscle) or inflammation.
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A computerized tomography scan of the orbits revealed a bony dehiscence of the medial wall of the orbit and soft tissue changes of the intraorbital injury (Figure 2).
Ocular motility and fundus photographs for Case 1. (A) Nine positions of gaze. Eye movements in the right eye were full. There is complete loss of adduction of the left eye. (B) Fundus photographs.. Notes: The right eye was normal. There is a macular cherry red spot with arterial narrowing in the left eye.
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The left eye was unable to adduct and there was a large angle left exotropia in primary gaze (Figure 3A). In the left eye, there was a macular cherry red spot with arterial narrowing (Figure 3B).
PMC3607413_02
Magnetic resonance (MR) images of the orbits for Case 2. (A) Coronal unenhanced T1-weighted MRI image, approximately 24 hours after surgery, shows a T1 isointense collection in the inferonasal quadrant of the right orbit (arrow), which was most consistent with a hematoma. There is also a bony defect in the medial and inferomedial wall of the orbit (arrowhead) adjacent to the hematoma representing the site of bony penetration. (B) Axial unenhanced T1-weighted MR image from a follow-up MRI, one month after surgery, shows resolution of the hematoma, but there is right enopthalmos and deviation of the globe medially.. Notes: The abnormal position of the globe associated with an abnormal signal in the inferonasal aspect of the orbit (arrow, and seen on other images from MRI) is consistent with fibrotic tissue causing globe/muscle tethering.
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A magnetic resonance imaging (MRI) scan of the orbits revealed a hematoma in the inferonasal quadrant of the right orbit (Figure 4A). A follow-up MRI showed fibrosis in the inferonasal aspect of the orbit (Figure 4B).
Ocular motility and fundus photographs for Case 2. (A) Nine positions of gaze. The right eye does not move in any direction. (B) Fundus photographs.. Note: The right optic nerve pallor with cupping.
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There was complete ophthalmoplegia of the right eye (Figure 5A). Dilated fundus examination of the right eye revealed a pale optic nerve with cupping, but was otherwise unremarkable (Figure 5B).