my daughter had an injury to her eye and had surgery 9 days ago, lower orbital fracture and entrapped muscle. The fracture was repaired and the muscle released. The surgery was 7 hours after the incident. She has no exterior symptoms, headaches or bruising now. However, she can't move that eye all the way up or down still and has double vision when she does that with both eyes. Is it normal to still have loss of movement after surgery? Could the muscle have died or other concern?
Is It Common to Have Restricted Eye Movement Up After an Eye Orbit Fracture, Entrp Muscle?
Doctor Answers 7
Trapdoor fractures are more common in children. Trapdoor fracture will cause the bones under the eye to swing down and immediately back up which entraps extraocular muscles that restricts eye movement and cause the double vision. The healing process you describe is normal and the symptoms are due to the swelling. If the movement and vision of your daughter's eyes do not improve in the next few weeks, you should take her back to the surgeon who treated her or go & get a second opinion.
A fracture of the bones around the eye can cause double vision for two reasons:
1. Entrapment of the muscle within the broken bone fragments.
2. Swelling of the muscle, fat and connective tissue within the orbit due to bleeding or inflammation.
If a muscle is entrapped, surgery is indicated to release the muscle as was done with your daughter. However, the residual swelling within the orbit or possibly a residual blood clot within the previously trapped muscle may be limiting her eye movements and causing double vision. It can take approximately 6 weeks to 3 months in some cases for all of the swelling to resolve, so patience is necessary.
However, if the vision in this eye alone is worsening or the double vision is worsening you need to return to your surgeon immediately to ensure to no additional bleeding occurred.
Nine days after surgery, restricted movement is most likely due to swelling in the orbit. It is unlikely that the muscle has necrosed (died) as this would usually present with excruciating pain, but it is possible that the muscle is still stuck in place due to entrapment or scarring. Your surgeon can test for this by manually mobilizing the eye with forceps.
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Postoperative motility deficits following inferior orbital floor procedures are not uncommon and tend to resolve. One question is, if they were able to release the entrapment with or without placing an implant on the floor of the orbit. In my experience, if it was felt that at the time of surgery the entrapment was relieved, motility deficits this early out from the procedure is generally due to post-op swelling and contusion (the muscle is bruised from the double trauma of the initial insult and the surgery) of the inferior rectus and/or inferior oblique muscles. Generally, this resolves over a period of time. I agree that a short course of steroids might be in order. In addition, if she is not having significant pain that is not resolving or is worsening, the muscle is viable. I hope this helps.
Following a orbit floor fracture, the eye muscles and/or connective tissues can become entrapped within the fracture, especially the inferior rectus muscle. In this situation, surgery is indicated the release the muscle or tissues. Following the surgery, the eye movement can resticted for many reasons; edema(most common), and inflammation. These conditions improve with time.
Dr. Crosby's note is correct. You should ask the managing ophthalmologist whether adding steroids might be helpful to reduce swelling associated with the original trauma and the subsequent surgery. This might shorten the healing time. Occasionally, the surgeon may place a "plate" over the fracture site. While this is often necessary if the fracture is sufficiently large, there may be additional resultant swelling, scarring, and restricted eye movement.
Ask your managing ophthalmologist to refer your daughter to a strabismus (eye misalignment) specialist. Pediatric ophthalmologists are particularly experienced in managing persistent diplopia (double vision), sometimes with prism glasses, sometimes with additional (eye muscle) surgery.
Good luck!
Most likely the muscles are still swollen and mobility and double vision will improve over the next few weeks. Discuss with your surgeon.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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