• FP-0799: PURE EXTRAOCULAR MANIFESTATIONS OF BLUNT TRAUMA

DR. ANKITA MULCHANDANI DR.ANJALI ISRANI

DR. MEHUL SHAH DR.SHREYA SHAH

THE AUTHORS HAVE NO FINANCIAL INTERESTS TO DISCLOSE.

TOKEN NO:0348 :PURE EXTRAOCULAR MANIFESTATIONS OF BLUNT TRAUMA

Dr. ANKITA MULCHANDANI Dr. NARAYAN ALANEDr. MEHUL A. SHAH Dr. SHREYA SHAHDR. ANAND TIBDEWAL

THE AUTHORS HAVE NO FINANCIAL INTERESTS TO DISCLOSE.

INTRODUCTION

• Trauma is a known cause of monocular blindness.

• Ocular trauma may affect lacrimal canaliculi, extraocular muscles , or intraocular structures and present in a variety of ways.

• Blunt trauma may present with only extraocular manifestations.

• Lid lacerations are common with ocular injuries,[1,2] while an association with lacrimal passage injuries is less common.[1]

• The traumatic rupture of extra-ocular muscles is rare.

• We observed all three injuries in one patient and successfully repaired the conjunctiva, lacrimal canal, inferior rectus muscle, during a single procedure.

CASE REPORT• A 25 year old male presented to our outpatient department following

an injury to the lid of his left eye (OS), caused by an iron rod.

On examination,• Vision (Os)- 6/6• Hypertropia• Inability To Move Downwards• Injury To The Lower Lid Involving The Lacrimal Canal (Fig-1.)• A Tear In The Conjunctiva• Ruptured Inferior Rectus Muscle (Fig-3.).• Hypertropia Of The Os And Absent Inferior movement in the

affected eye.

• The eyelid was repaired surgically in layers considering grey line .

• The ruptured lacrimal canal was repaired using the Teflon sleeve of a 22G Intracath (Fig-2.), which was left in place for 6 weeks.

• We located the proximal end of the canal and confirmed it by syringing.

• We found the proximal end of the inferior rectus muscle and sutured it to the distal end, achieving proper strength, as detected by orthophoria in the primary position and inferior movements at the end of the repair (Fig-2.).

Fig 1 • Lower lid tear involving proximal and distal canaliculus.

Fig 2

• Ruptured lacrimal canal repaired with Teflon sleeve which was left in place for 6 weeks

Fig 3

• Conjunctival tear being sutured.

• Promixal and distal ends of inferior rectus being sutured.

Fig 4

• Patient was treated with local and systemic antibiotics and corticosteroids post operatively.

• The patient complained of diplopia in the early postoperative period.

• This was evaluated with diplopia charts and the patient improved slowly, both subjectively and objectively.

• The patient achieved orthophoria and full movement in inferior gaze.

Discussion:•Lid lacerations and repair have been reported, with or without involvement of the lacrimal canal.

• However, a laceration involving the lid, lacrimal canal, and extra-ocular muscle is unique and the successful repair of all components during a single procedure has not been reported.

•Lacrimal canal lacerations are common in ophthalmic practice, but direct injury to the canal is reported only in 16% to 54% [7] of cases.

Discussion:• Variable success rates have been reported for lacrimal canal repair

using different techniques, including a pig tail needle [2] or silicon tube for intubation, or a mini-monoka.[5]

• There are few reports on the rupture of extra-ocular muscles.[4-7] Rupture of the inferior rectus has been reported in three studies.[4,7], Harish et al. reported rupture of the superior oblique,[7] while Sari et al. reported the rupture of three rectus muscles in blunt trauma.[6]

Conclusion:

• An extra-ocular injury involving the conjunctiva, lid, lacrimal passages, and extra-ocular muscles can be repaired successfully during a single procedure.

References:1) Lima-Gómez V, Mora-Pérez E Ocular lesions associated with lid

wounds with or without tear duct affection Cir Cir.2006 ;74:11-4.[Article in Spanish]

2) Walter WL. Ophthalmic Surg. The use of the pigtail probe for silicone intubation of the injured canaliculus.1982;13:488-92.

3) Naik MN, Kelapure A, Rath S, Honavar SG Management of canalicular lacerations: epidemiological aspects and experience with Mini-Monoka monocanalicular stent. Am J Ophthalmol.2008 ; 145:375-380.

4) Sari A, Adiguzel U, Ismi T. An unexpected outcome of blunt ocular trauma: rupture of three muscles. Strabismus 2009; 17:95-7.

5) .Harish AY, Ganesh SC, Narendran K. Traumatic superior oblique tendon rupture. J Aapos 2009;13:485-7.

6) O'Toole L, Long V, Power W, O'Connor M. Traumatic rupture of the lateral rectus. Eye (Lond) 2004;18:221-2

7) Ling R, Quinn AG. Traumatic rupture of the medial rectus muscle. J Aapos 2001 ;5:327-8.