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Cauterization-mediated restriction from penetrating orbital trauma
Daniel L Liebman1, Marguerite C Weinert2, Jenny C Dohlman2
1Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Summary
A penetrating eye injury from a hot skewer caused medial rectus restriction and strabismus. The patient experienced significant spontaneous recovery of eye movement over six months.
Area of Science:
- Ophthalmology
- Trauma Surgery
Background:
- Penetrating periocular trauma can lead to complex ocular motility disorders.
- Thermal injury to extraocular muscles is a rare mechanism of strabismus.
Observation:
- A 32-year-old woman sustained a penetrating thermal injury to the left periocular adnexa.
- Clinical examination revealed left esotropia with complete limitation of abduction and a downshoot in left gaze.
- Imaging showed medial rectus muscle thickening and fat stranding without fracture.
Findings:
- The patient was diagnosed with thermal cauterization injury causing left medial rectus restriction.
- Remarkable spontaneous improvement in ocular motility occurred over six months.
- Residual esotropic diplopia in left gaze persisted despite initial recovery.
Implications:
- Isolated extraocular muscle thermal injuries can lead to spontaneous strabismus recovery.
- Longitudinal observation may be beneficial before surgical intervention for such injuries.
- Medial rectus recession successfully addressed residual diplopia, indicating surgical options remain viable.
