Acute transient large-angle exotropia caused by traumatic orbital contusion

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Neuro-ophthalmology

Background:

• Blunt orbital trauma can lead to significant ocular motility disturbances.
• Exotropia, particularly acute large-angle forms, requires prompt diagnosis and management.

Observation:

• An 8-year-old boy presented with acute large-angle left exotropia and limited left eye adduction post-trauma.
• Associated findings included microhyphema and commotio retinae in the left eye.

Findings:

• High-resolution orbital MRI revealed significant perimuscular and intramuscular edema of the medial and lateral rectus muscles.
• Extraocular muscle insertions were intact, suggesting non-disruptive injury.

Implications:

• Systemic steroid therapy led to complete resolution of strabismus and adduction limitation within 24 hours.
• High-resolution MRI is crucial for evaluating extraocular muscle injuries.
• Non-surgical management with steroids is effective when imaging excludes muscle disinsertion or rupture.