The treatment of patients suffering from diplopia caused by displacement of the eyeball, due to fracture of the orbital wall

Abstract

DOUBLE vision occurring in a person who has previously enjoyed binocular single vision can be a distressing symptom and one which not only causes considerable social embarrassment, but prevents the sufferer from taking part efficiently in those activities which depend on the accurate judgment of the relative position of objects. It may even prejudice his safety and that of others if he attempts to drive a motor-car. In the past, diplopia of traumatic origin was usually regarded as something that must be accepted--something about which nothing could be done--and the unfortunate sufferer was instructed to wear a patch over one eye, or perhaps encouraged by the inaccurate statement that in time he would get used to it and would manage to concentrate upon the vision of one eye, mentally neglecting that of the other eye. Such a thing can happen in people of dull intellect or of hysterical type (albeit with the loss of binocular depth perception), but in the average fairly introspective type of person it is exceptional. Double vision following dosed head injury is usually due to a lesion of one of the ocular motor nerves--fourth, sixth, or third in that order of frequency-and in a certain percentage of cases spontaneous recovery of nerve function occurs, usually within six months, and diplopia disappears, although in other cases diplopia persists with a residual and permanent defect of ocular movement, necessitating surgical treatment of the extrinsic ocular muscles. On the other hand, double vision caused by head injury involving fracture of the orbital wall is usually due to a displacement of the eyeball with a deviation of its visual axis, so that the visual axes of the two eyes can no longer be directed towards the same object of fixation. Sometimes both eyes may be displaced, causing a greater complexity in the resulting deviation. As regards injuries of the orbit it must, however, be realised : -