Clinical characteristics and surgical outcomes of isolated inferior rectus palsy

Abstract Aim As isolated inferior rectus muscle (IRM) palsy represents a rare clinical entity, very limited information is available on this condition. The aim of this report was to elucidate the etiology, clinical characteristics and surgical outcomes of isolated IRM palsy. Methods Isolated IRM palsy cases who underwent surgical treatments at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China over the period from January 2008 to June 2019 were reviewed retrospectively. Data evaluated from these cases included their etiology, ocular alignment, ocular motility, surgical procedures and surgical outcomes. Results A total of 61 patients (40 males, 21 females) were included in this review. Their mean ± SD age was 27.21 ± 16.03 years (range: 2 to 73 years). In these cases, 32 (52.5%) involved traumatic injury, 28 (45.9%) congenital hypoplasia or absence of inferior rectus and 1 (1.6%) with thyroid ophthalmopathy. The right eye was affected in 33 patients (54.1%), the left in 24 patients (39.3%), and both eyes in 4 patients (6.6%). The main clinical presentations consisted of hypertropia of the affected eye, motility limitation in abduction and depression and incyclotropia. After treatment consisting of various surgical approaches, including muscle repair or resection of the affected inferior rectus, recession of ipsilateral superior rectus, elongation of contralateral superior oblique and partial transposition of the horizontal rectus, the isolated IRM palsy was rectified in 49 patients (80.4%) with one surgery, while 11 cases (18.0%) required two surgeries and 1 case (1.6%) needed three surgeries. Finally, 52 patients (85.2%) showed a complete recovery, 6 (9.9%) improved and 3 (4.9%) experienced a surgical failure. Conclusion The main etiologies of isolated IRM palsy involved traumatic injury and developmental events. Overall, surgical outcomes of the various approaches employed were quite effective.

Download Full-text

A rare case of early massive monomuscular fibrosis causing severe unilateral euthyroid Graves’ ophthalmopathy in a smoker patient with dyslipidemia

10.21203/rs.3.rs-845782/v1 ◽

2021 ◽

Author(s):

Giuseppe Frazzetto ◽

Maria Luisa Arpi ◽

Concetto Regalbuto ◽

Antonino Belfiore ◽

Francersco Frasca ◽

...

Keyword(s):

Rare Case ◽

Thyroid Autoimmunity ◽

Clinical Manifestations ◽

Severe Depression ◽

Rectus Muscle ◽

Pulse Therapy ◽

Ocular Motility ◽

Inferior Rectus ◽

The Right

Abstract BackgroundGraves’ ophtahlmopathy (GO) is an autoimmune manifestation of orbit affecting about 25% of patients with Graves’ disease (GD). Autoreactive T cells involved in thyroid autoimmunity can recognize the thyroid stimulating receptor (TSHr) expressed in orbit tissues of GO patients. Clinical manifestations of GO are rather different depending of the presence of some risks factors as smoke, hyperthyroidism duration, age, biological activity of anti TSHr antibodies (TSH-R-Ab) and metabolic diseases.Case presentation:here we present a rare case of euthyroid single muscular GO in a 50 years old patient, he was smoker and had dyslipidemia from several years. The patient experienced a very rapid and severe depression of ocular motility of the right eye that causes an uncorrectable and constant diplopia severely affecting his quality of life. He was euthyroid and TSH-R-Ab plasmatic levels were only slightly elevated. Intravenous corticosteroids pulse therapy was partially effective and two rounds of wall orbital surgical decompression was necessary. A massive mono-muscular fibrosis was evidenced by biopsy of right inferior rectus muscle.Conclusionssevere unilateral, mono-muscular GO in a euthyroid Graves’ patient was found to be sustained by rapid and massive fibrosis of the inferior rectus muscle of right orbit, the clarification of pathogenetic mechanisms of these GO clinical forms requires further studies.

Download Full-text

Modified Muscle Transposition Procedure for a Case of Inferior Rectus Muscle Aplasia

Case Reports in Ophthalmology ◽

10.1159/000371508 ◽

2014 ◽

Vol 6 (1) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Shinji Makino ◽

Kozue Hozawa ◽

Reiko Kondo ◽

Mika Kanai ◽

Haruko Suto ◽

...

Keyword(s):

Rectus Muscle ◽

Ocular Motility ◽

Downward Movement ◽

Inferior Rectus ◽

Muscle Transposition ◽

Magnetic Resonance Imaging Mri ◽

Operative Findings ◽

The Right ◽

Superior Rectus Muscle ◽

Inferior Rectus Muscle

Purpose: We report a case of inferior rectus muscle aplasia in a 65-year-old woman. Methods: Images were obtained using ocular motility photography and magnetic resonance imaging (MRI), and operative findings were analyzed. Results: A 65-year-old woman presented with marked right hypertropia. The right eye also had microcornea, iris coloboma, and completely restricted downward movement. MRI showed absence of the inferior rectus muscle in both eyes. During surgery, it was confirmed that the right inferior rectus muscle was absent. The patient underwent a muscle transposition procedure without tenotomy or muscle splitting. A superior rectus muscle tenotomy was also performed. Postoperatively, the right eye showed hypotropia and improved downward movement. Conclusion: Muscle transposition without tenotomy or tendon splitting is a surgical option for the unusual abnormality presented in this paper.

Download Full-text

Neurological deficit due to cement extravasation following a vertebral augmentation procedure

Journal of Neurosurgery Spine ◽

10.3171/2013.4.spine12978 ◽

2013 ◽

Vol 19 (1) ◽

pp. 61-70 ◽

Cited By ~ 16

Author(s):

Gursukhman S. Sidhu ◽

Christopher K. Kepler ◽

Katherine E. Savage ◽

Benjamin Eachus ◽

Todd J. Albert ◽

...

Keyword(s):

Surgical Management ◽

Neurological Deficit ◽

Traumatic Injury ◽

Complete Recovery ◽

Cement Leakage ◽

Neurological Status ◽

The Right ◽

Cement Extravasation ◽

Removal Of Cement ◽

Biplanar Fluoroscopy

The authors endeavor to highlight the surgical management of severe neurological deficit resulting from cement leakage after percutaneous vertebroplasty and to systematically review the literature on the management of this complication. A patient presented after a vertebroplasty procedure for traumatic injury. A CT scan showed polymethylmethacrylate leakage into the right foramina at T-11 and L-1 and associated central stenosis at L-1. He underwent decompression and fusion for removal of cement and stabilization of the fracture segment. In the authors' systematic review, they searched Medline, Scopus, and Cochrane databases to determine the overall number of reported cases of neurological deficit after cement leakage, and they collected data on symptom onset, clinical presentation, surgical management, and outcome. After surgery, despite neurological recovery postoperatively, the patient developed pneumonia and died 16 days after surgery. The literature review showed 21 cases of cement extravasation with neurological deficit. Ultimately, 15 patients had resolution of the postoperative deficit, 5 had limited change in neurological status, and 2 had no improvement. Cement augmentation procedures are relatively safe, but certain precautions should be taken to avoid such complications including high-resolution biplanar fluoroscopy, considering the use of a local anesthetic, and controlling the location of cement spread in relationship to the posterior vertebral body. Immediate surgical intervention with removal of cement provides good results with complete recovery in most cases.

Download Full-text

Lymphocutaneous Sporotrichosis Refractory to First-Line Treatment

Case Reports in Dermatological Medicine ◽

10.1155/2021/9453701 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Walter Belda ◽

Luiz Felipe Domingues Passero ◽

Ana Thereza Stradioto Casolato

Keyword(s):

Amphotericin B ◽

Potassium Iodide ◽

Traumatic Injury ◽

Complete Recovery ◽

Skin Lesions ◽

First Line ◽

Amphotericin B Deoxycholate ◽

The Right ◽

Line Drug ◽

Control Skin

Sporotrichosis is a fungal infection endemic in Latin America and has been attributed to the thermodimorphic fungus of the genus Sporothrix. Transmission to humans occurs during a traumatic injury with soil or organic material; additionally, lesions caused by infected cats play an important role in the epidemiology of the disease. The classic treatment of sporotrichosis is performed with itraconazole or potassium iodide; second-line medications, such as amphotericin B and terbinafine, can alternatively be used in cases of first-line drug failure. In the present study, a patient with lymphocutaneous sporotrichosis in the right upper limb exhibited intolerance to itraconazole and potassium iodide, additionally during the period of use; these drugs did not control skin lesions. In this patient, amphotericin B deoxycholate and its liposomal version were used in this patient; and complete recovery of the lesions was observed.

Download Full-text

Isolated rectus muscle rupture following trauma

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v7i2.14976 ◽

2016 ◽

Vol 7 (2) ◽

pp. 182-185 ◽

Cited By ~ 2

Author(s):

Halil Hüseyin Çağatay ◽

Metin Ekinci ◽

Şendoğan Ulusal ◽

Mehmet Ersin Oba ◽

Zeliha Yazar

Keyword(s):

Treatment Options ◽

Rectus Muscle ◽

Inferior Rectus ◽

Primary Position ◽

Initial Surgery ◽

Muscle Rupture ◽

The Right ◽

Periorbital Swelling ◽

Cover Test

Background: Isolated rectus muscle ruptures are rare ophthalmic emergencies which may result in permanent diplopia. Objective: To highlight updates on clinical features, surgical treatment options and potential complications for isolated inferior rectus ruptures. Case: A 39-year-old man came to our emergency department complaining of diplopia and upward deviation of the right eye after experiencing an animal injury. Extraocular movements were limited in the right eye in the downgaze position. The alternate prism and cover test, both at distance and near testing, showed hypertropia of 40 prism diopters (PD) of the right eye. The right eye had periorbital swelling and conjunctival haematoma. An inferior rectus rupture repair was performed under local anesthesia and monitored sedation. Follow-up examination revealed a 20 PD hypertropia, causing diplopia in all gazes. A second surgical intervention was planned six months after the initial surgery, an inferior rectus 6 mm resection was performed, after which orthophoria was achieved in the primary position both at distance and near testing.

Download Full-text

Ptosis: a rare presentation of ocular cysticercosis

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i1.7842 ◽

2013 ◽

Vol 5 (1) ◽

pp. 133-135 ◽

Cited By ~ 1

Author(s):

RK Labh ◽

AK Sharma

Keyword(s):

Rectus Muscle ◽

Oral Steroid ◽

Enzyme Linked Immunosorbent Assay ◽

Ocular Motility ◽

Upper Eyelid ◽

Superior Rectus ◽

Mild Pain ◽

Ocular Cysticercosis ◽

The Right ◽

Superior Rectus Muscle

Background: Cysticercosis is a common parasitic infection involving multiple systems and caused by Cysticercus cellulosae, the larval form of the cestode, Taenia solium. The humans become infected by ingesting its eggs from contaminated food. Here, we present a case of ocular cysticercosis which presented with mild pain, ptosis, inflammation of upper eyelid and slightly restricted ocular motility. Case: A twelve-year-old girl presented with mild pain, unilateral ptosis and inflammation of the right upper eyelid for seven months. There was no history of diurnal variation and trauma. There was neither protrusion of the eyeball nor any mass was palpable in periorbital area. Visual acuity in both the eyes was normal. Periocular and ocular examination revealed a slightly restricted ocular motility in the right upward gaze and a reduced vertical fissure height a with good levator palpebrae function. The Bell’s phenomenon was good. The magnetic resonance imaging of the orbit showed an intra-conal retro-orbital mass involving the superior rectus muscle of the right eye suggestive of ocular cysticercosis. The orbital sonogram revealed a cystic lesion in the superior rectus muscle with an echogenic intramural nodule. The enzyme-linked immunosorbent assay for serum antibodies against the cysticercus was positive. The ptosis improved with a therapeutic trial of albendazole and oral steroids for 6 weeks. Conclusion: Extra-ocular cysticercosis can be treated with oral steroid and albendazole. Nepal J Ophthalmol 2013; 5(9):133-135 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7842

Download Full-text

Instantaneous Reconstruction of Inferior Rectus: Asset for Vision

Journal of Surgical Case Reports and Images ◽

10.31579/2690-1897/011 ◽

2020 ◽

Vol 3 (1) ◽

pp. 01-03

Author(s):

Sanjoy Chowdhury ◽

Madhumita Srivastava ◽

Nilanjan Chowdhury

Keyword(s):

Rectus Muscle ◽

Penetrating Injury ◽

Effective Procedure ◽

Inferior Rectus ◽

Anterior Transposition ◽

Eye Examination ◽

The Right ◽

Orbital Lesions ◽

Inferior Rectus Muscle

Orbital lesions are frequent findings after blunt periocular trauma causing diplopia, muscle avulsion etc. Four patients presented with diplopia after a penetrating injury to the right eye. Examination revealed right hypertopia and limitation of infraduction of right eye with rupture of Inferior Rectus. Immediate repair of inferior rectus muscle with anterior transposition of inferior oblique is a safe and effective procedure to restore motility

Download Full-text

Pure Orbital Trapdoor Fractures in Adults: Tight Entrapment of Perimuscular Tissue Mimicking True Muscle Incarceration with Successful Results from Early Intervention

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0038-1625965 ◽

2019 ◽

Vol 12 (1) ◽

pp. 54-61 ◽

Cited By ~ 1

Author(s):

Ioannis Papadiochos ◽

Vasilis Petsinis ◽

Jason Tasoulas ◽

Lampros Goutzanis

Keyword(s):

Soft Tissues ◽

Case Reports ◽

Full Range ◽

Case Series ◽

Rectus Muscle ◽

Ocular Motility ◽

Inferior Rectus ◽

Retrospective Case ◽

Orbital Trauma ◽

Specific Subset

Orbital trapdoor fractures (OTFs) entail entrapment of intraorbital soft tissues with minimal or no displacement of the affected bones and are almost exclusively seen in children. This article aimed to report the diagnosis and treatment of an OTF of the floor in an adult patient and to critically review the literature regarding the management aspects of this specific subset of orbital blowout fractures in adults. A 29-year-old man presented with limitations of vertical right eye movements owing to blunt orbital trauma. The patient mainly complained of double vision in upper gazes and some episodes of nausea. Neither floor defect nor significant bone displacement found on orbital computed tomography, while edema of inferior rectus muscle was apparent. The patient underwent surgical repair 5 days later; a linear minimally displaced fracture of the floor was recognized and complete release of the entrapped perimuscular tissues was followed. Within the first week postoperatively, full range of ocular motility was restored, without residual diplopia. This case was the only identified pure OTF over a 6-year period in our department (0.6% of 159 orbital fractures in patients >18 years). By reviewing the literature indexed in PubMed, a very limited number of either of isolated case reports or retrospective case series of pure OTFs has been reported in adults. Contrary to the typical white-eyed blowout fractures, the literature indicates that OTFs in adults seem to not always constitute absolute emergency conditions. Although such fractures need to be emergently/ immediately treated in children, in the absence of true muscle incarceration, adults may undergo successful treatment within a wider but either early or urgent frame of time. Adults frequently exhibit vagal manifestations and marked signs of local soft tissues injury.

Download Full-text