PMC8269767_01
Preoperative clinical findings following initial injury. 1a. Ocular motility, 1b. Hess chart shows compression in the right eye.
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F1
This corresponded with the Hess chart findings which consisted of a compressed pattern in the right eye and an expanded pattern in the left eye (Figure 1).
CT scan of orbit using soft tissue windows. 2a Orbital floor fracture following initial injury. 2b. Coronal section following orbital floor repair. The bodies of the left and right medial recti have been highlighted to demonstrate their asymmetric positioning. The right medial rectus is clearly elevated in comparison to the contralateral side. 2c. Coronal section of the orbit shows the medial rectus tendon in close proximity to and distorted by the orbital plate. Anatomical structures are labelled, * indicates the globe. 2d. Sagittal section shows posterior extension of orbital plate. 2e. Coronal section following orbital plate exchange shows right medial rectus now symmetrical with left. 2f. Sagittal section following orbital plate exchange shows less posterior extension of orbital plate.
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A CT performed at this time demonstrated a right orbital floor fracture with orbital fat herniating into the maxillary sinus (Figure 2). A CT was performed, which showed changes in the position of medial rectus and inferior rectus following orbital plate insertion (Figure 2). Figure 2c demonstrates the medial rectus tendon appearing to ride on the border of the orbital plate. The repeated CT scan showed return of the medial rectus to a normal position (Figure 2).
Postoperative clinical findings following orbital floor repair. 3a. Ocular motility, 3b. Synoptophore performed postoperatively with left eye fixating. Esotropia, excyclotorsion and mild left hypertropia noted in primary position. Left hypertropia maximal in dextroelevation. Esotropia was present in all positions of gaze and maximal in dextrodepression. Excyclotorsion was maximal in levoversion. 3c. Hess chart showing a compressed appearance in the right eye. Note restriction of upgaze in the right eye with associated overaction of the left superior rectus and underaction of right inferior oblique, medial rectus and inferior oblique.
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He was found to have a right hypotropia and excyclotorsion maximal on levoversion of up to 10 degrees on synoptophore (Figure 3).
Postoperative clinical findings following orbital plate exchange. 4a. Ocular motility, 4b. Synoptophore, left eye fixation, no torsion in any position of gaze, 4c. Hess chart.
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Examination revealed return of normal ocular motility and no significant torsion (Figure 4).