Binocularity and severe uniocular trauma

Monocular outcomes following severe ocular trauma are well described, but little is known about the effect of such injuries on binocular visual outcomes. We therefore report the binocular outcomes in a series of patients with such injuries.

A retrospective analysis was undertaken of 6 patients with binocular problems following ocular injuries that were severe enough to warrant referral to the regional centre for vitreoretinal surgery.

Mean age: 24 years. Mean follow-up: 2.9 years. All patients had 1 to 5 vitreoretinal procedures and the final visual acuities ranged from 6/9 to 1/60. Three patients regained some binocularity, 2 had intractable diplopia and 1 was 'suppressing' with prisms. The final visual acuity did not predict the binocular outcome. The time delay between the original injury and presentation at the motility service was between 3 months and 2.25 years.

A good monocular visual outcome does not necessarily result in a satisfactory binocular visual outcome and a poor monocular visual outcome does not prevent severe binocular symptoms. Patients need to be counselled regarding this risk, which is an under-recognised problem. We also recommend that all such patients be referred promptly for a thorough orthoptic assessment.