Detecting Binocular Diplopia in Orbital Floor Blowout Fractures: Superiority of the Orthoptic Approach.

Juraj Timkovic,Petr Handlos,Hana Tomaskova,Jan Stembirek,Jaroslav Janosek,Jiri Stransky

doi:10.3390/medicina57090989

Abstract

Background and Objectives: In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical therapy. However, the accuracy of the traditional test for detecting binocular diplopia/ocular motility disorder using a moving pencil or finger (hereinafter, “finger test”) has been generally accepted as correct and has not been subject to scrutiny so far. Hence, its accuracy relative to full orthoptic examination is unknown. Materials and Methods: In this paper, the results of the “finger test” were compared with those derived from a complex examination by orthoptic tests (considered “true” value in patients with OFBF). Results: “Finger test” detected ocular motility disorder in 23% of patients while the full orthoptic examination proved much more efficient, detecting ocular motility disorder in 65% of patients. Lancaster screen test and test with color filters were the most important tests in the battery of the orthoptic tests, capable of identifying 97.7% and 95.3% of patients with ocular motility disorder, respectively. Still, none of the tests were able to correctly detect all patients with ocular motility disorder in itself. Conclusions: As the presence of ocular motility disorder/binocular diplopia is an important indication criterion for the surgical solution of the orbital floor blowout fracture, we conclude that a complex orthoptic evaluation should be always performed in these patients.

Highlights

Binocular diplopia is one of the most common problems arising as a result of orbital floor blowout fractures (OFBF) and, at the same time, an important criterion in deciding whether to treat the patient conservatively or surgically [1,2]
Hereinafter, we will refer to this examination as a “finger test”, which is typically performed by a maxillofacial surgeon and diplopia is reported by the patient; and (ii) by a complex ophthalmological and orthoptic examination performed by an ophthalmologist
Out of the 66 patients participating in our study, 45 were male and 21 were female. 31 patients were treated surgically, 35 conservatively. 43 patients (65.2%) with isolated orbital floor blowout fracture had an ocular motility disorder and out of these, 41 suffered from binocular diplopia detected by a complex orthoptic examination

Summary

Introduction

Binocular diplopia is one of the most common problems arising as a result of orbital floor blowout fractures (OFBF) and, at the same time, an important criterion in deciding whether to treat the patient conservatively or surgically [1,2]. It is, necessary to note that binocular diplopia is just one manifestation of the ocular motility disorder (OMD) that can arise as a result of herniation of soft orbital tissues in the defect and that such herniation is, in principle, the cause for referring patients for surgical solution [3–5]. Conclusions: As the presence of ocular motility disorder/binocular diplopia is an important indication criterion for the surgical solution of the orbital floor blowout fracture, we conclude that a complex orthoptic evaluation should be always performed in these patients

Methods

Results

Discussion

Conclusion