Session: Poster session C

Surgical management of a complete traumatic superior oblique rupture

Leena PATEL¹, Katie WILLIAMS^1,2,3, Aditi DAS¹

¹Moorfields Eye Hospital Foundation Trust, London, United Kingdom
²Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
³Kings College London, London, United Kingdom

Introduction

We describe the surgical management of a 26-year-old patient with complete avulsion of the left superior oblique muscle secondary to childhood trauma.The patient suffered from a left penetrating orbital injury from a hook at the age of 13. He presented with a large angle incomitant vertical deviation controlled by a large compensatory head posture.

Methods

This patient was referred for a second opinion regarding troublesome vertical diplopia which he controlled with a significant head posture. He had undergone previous lid surgery as a child but no strabismus surgery. On clinical examination, he had excellent visual acuities in either eye: Right 0.06 and Left 0.14. Orthoptic assessment revealed a left hypertropia measuring 25^L/R in primary position, increasing to 45^L/R in right gaze. There was no significant measurable torsion (1° right incyclortosion and 1° left excyclotorsion in primary position, similar in right gaze and depression). Ocular motility showed a -2 underaction of his left superior oblique and a +3 overaction of the ipsilateral inferior oblique. He adopted a large compensatory head posture (right head tilt with chin depression), with which he was able to maintain single vision and demonstrate motor fusion and stereopsis. Anterior and posterior examination of his eyes was normal. MRI imaging showed a largely absent superior oblique, bar the tendon and trochlear. This patient was managed through a multidisciplinary approach and will undergo staged strabismus surgery to address his vertical diplopia and head posture.

Conclusion

Surgical management of traumatic strabismus can be complex.This patient is due to have staged strabismus surgery to his left eye, commencing with left inferior oblique recession and potentially right inferior rectus recession +/- nasal transposition depending on initial post operative results. We will present our pre and post operative results with photographs in 9 positions of gaze, MRI images and patient videos.