Ocular motility disturbances following trauma

Disturbances of ocular motility following trauma are manifested by diplopia and faulty ocular rotations which frequently require an abnormal head position for fusion. Motility imbalance may occur following injury to the eye alone, to the eye and associated extraocular muscles, and to the orbital walls, and also following closed head trauma. The clinical findings early following injury may be very different from the clinical picture several months following injury. The diagnosis of abnormal motility includes the use of forced ductions, saccadic velocity recording, active force generation, measurements of deviations of the eyes in the cardinal positions of gaze as well as the use of computed tomography (CT scan) and ultrasonic techniques. The presence of slipped or lost muscles must be diagnosed, and evaluation of restricted rotations and paretic muscles is essential. The treatment of motility disturbance includes relief of restricted rotations by lysis of adhesions and lengthening or recessing appropriate muscles as well as strengthening underacting muscles by resection and/or advancement. In cases of severe trauma one must not overlook injury to the eye itself in addition to the motility disturbance.