Session: Poster session C

And her smile came back

Introduction

          A three-year-old female patient presented to our ophthalmic emergency unit with a post-traumatic severe left eye retrobulbar hematoma, and marked proptosis. Her orbital imaging revealed optic nerve avulsion.

          One month later, she was referred to the strabismus unit due to marked left hypotropia with limitation in elevation. Her visual acuity in the affected eye was no perception of light (NPL) due to optic nerve avulsion.

          Throughout the examinations, she consistently displayed a depressed mood with a noticeable absence of her usual smile attributed to concerns related to poor cosmesis.

Purpose

          To demonstrate our approach to planning and reconstructing extraocular muscles following severe ocular trauma resulting in optic nerve avulsion and a torn superior rectus muscle. Additionally, our aim is to illustrate the emotional impact on the patient, who consistently exhibited sadness during all examinations. Subsequent to the transposition surgery of extraocular muscles, despite her ongoing visual acuity NPL, the patient experienced a positive change, regaining her smile.

Patients and methods

          The procedure involved dissection and excision of the upper symblepharon, along with exploration of the superior rectus muscle. During the exploration, we identified a complete tear in the superior rectus muscle. Subsequently, we performed transposition of the superior oblique tendon to the site of the torn superior rectus, after shortening of the tendon. Additionally, a large recession of the inferior rectus muscle was done. 

Results

          The patient's postoperative cosmetic appearance was satisfactory, although her visual acuity was still NPL  her innocent childhood smile returned.

Conclusion

          Following strabismus surgery, we achieved success in improving the patient's emotional well-being, as evidenced by removal of symblepharon,  and restoration of her smile after correction of hypotropia.