Management of diplopia on down-gaze following orbital trauma

Diplopia in the inferior field due to orbital trauma is a notoriously difficult and disabling problem. Even if a blow-out fracture is repaired by current methods, patients may still have diplopia. There also exists another group in whom no demonstrable radiological fracture can be found, and yet there is a severe down gaze deficit. The possible mechanisms of this phenomenon are discussed and the results of horizontal muscle transposition surgery in a series of nine patients is reported. The authors conclude that this procedure is a valuable method of increasing the useful field of binocular single version in these patients.