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PubMed1975

Surgical management of persistent diplopia in blowout fractures of the orbit.

Persistent diplopia continues as a problem in a significant number of patients following the surgical management of a blowout fracture of the orbital floor even when repaired within 15 days of the traumatic incident. Inferior rectus and inferior oblique muscles which have been incarcerated in a blowout fracture for longer periods have a worse prognosis for adequate functioning postoperatively. There is some presumptive evidence to suggest a myogenic or neurogenic cause for such dysfunction. Experiments with posterior fractures clearly demonstrate that the nerve entering the inferior rectus can be damaged. Vertical diplopia which persists beyond 3 months following release of entrapped muscle tissue requires surgical correction depending upon the degree of vertical dissociation. Motility surgery was required in 18 of 20 patients with persistent diplopia. Multiple muscle combinations were frequently required to achieve success. The criterion for a successful result was elimination of vertical diplopia in the primary and reading position. The elimination of persistent diplopia in association with blowout fractures of the orbit is usually possible even in late treated cases when one uses specific criteria for success. Three cases were considered cured since there was no diplopia in any direction of gaze, while 17 cases developed single binocular vision in the primary and reading positions. In these latter patients, on extreme upward or downward gaze, diplopia could still be demonstrated in all patients, especially when the individuals were specifically requested to look for diplopia.

Diplopia↗
PubMed2004

Elimination of paradoxical diplopia following treatment with botulinum toxin and prism.

BACKGROUND: Paradoxical diplopia occurs when binocular visual cerebral cortex projection of diplopic images (the "subjective angle") is not commensurate and identical with angle or direction of strabismus (the "objective angle"). Its presence infers anomalous retinal correspondence and is manifest as heteronymous or crossed diplopia in esotropia and homonymous or uncrossed diplopia in exotropia. When treated, the prognosis for achieving fusion is poor, while the risk for intractable diplopia is reputedly high. We report a patient with paradoxical diplopia that resolved (and some binocular fusion developed) following botulinum toxin injections and prism therapy. RESEARCH DESIGN: Case report. CASE REPORT: A 25 year old man was evaluated for an exotropia. At age 4 years, he had acquired an esotropia due to a traumatic lateral rectus palsy. The esotropia resolved over 3 years. At age 14 years, he developed a consecutive exotropia. The exotropia was eventually treated surgically. There remained a residual exotropia following surgery, and he experienced paradoxical diplopia and projected it homonymously on all sensory tests as if he was esotropic. Treatment with botulinum toxin injections to both lateral rectus muscles along with a small prismatic correction in spectacles eliminated the exotropia and paradoxical diplopia, permitting some binocular fusion. CONCLUSION: Botulinum toxin injection and prism therapy can be effective in eradicating paradoxical diplopia.

Adult↗
PubMed2001

Persistent vertical binocular diplopia after cataract surgery.

PURPOSE: To report the incidence of, and factors associated with, persistent vertical diplopia after cataract surgery. DESIGN: Consecutive interventional case series. METHODS: Retrospectively, all adult patients examined during a five year, five month period because of new onset persistent (>3 months) vertical binocular diplopia after cataract surgery were analyzed. All patients had their cataract surgery at the same outpatient ophthalmic surgery center, and were referred to the author, enabling calculation of incidence. Trends in anesthesia type and strabismus complications therefrom were also assessed. Comparison was made between ophthalmologist-administered retrobulbar anesthesia versus anesthesia staff-administered retrobulbar anesthesia. Incidence during a period in which hyaluronidase was not incorporated in the retrobulbar anesthetic was calculated. RESULTS: Persistent vertical diplopia occurred after cataract surgery in 32 (0.18%) of 17,531 eyes that had cataract surgery. No patient whose cataract surgery was conducted with topical anesthesia (3817 eyes) had persistent vertical diplopia, whereas 32 (0.23%) of the 13714 eyes whose cataract surgery was done after retrobulbar anesthesia were affected. No cases of persistent postoperative diplopia were found among 7410 cataract surgery eyes after retrobulbar injection given by one cataract surgeon. There was a threefold greater number of left eyes involved than right eyes (P <.005). No significant (P >.20) increase in cases of persistent vertical diplopia was noted during a period of hyaluronidase shortage. CONCLUSIONS: In this study, persistent binocular vertical diplopia after cataract surgery occurred in 0.23% of cases in which retrobulbar anesthesia was performed. No cases were found after topical anesthesia. Occurrence may be technique-related.

Aged↗
PubMed2006

[Management of consecutive exotropia -- operative therapy and diplopia testing].

PURPOSE: The aim of this study was to investigate the diagnostic value of preoperative sensory testing on postoperative diplopia and to evaluate the dose-effect relations of medial rectus muscle or unilateral recess/resect advancement procedures and their constancy. METHODS: A retrospective evaluation of 62 operative cases of consecutive exotropia performed from 2001 to 2003 was carried out. Diplopia after prismatic correction and after converging by minus glasses was tested. In 47 cases a unilateral recess/resect procedure and in 15 cases an advancement of the medial rectus muscle were performed. The postoperative results were controlled one week and three months after operation by measuring the angle of squint by a prism cover test looking in five metres and in 33 cm. RESULTS: 22 patients (36 %) had neither diplopia after prismatic correction of angle of squint nor after operation. The other 40 patients (64 %) experienced diplopia, but were not troubled by it. In all patients the whole amount of angle of squint was operated. Immediately after operation, 14 patients (23 %) experienced diplopia temporarily, which remained after 3 months in 9 patients, but all of them were not disturbed by it. In all patients the mean preoperative angle of - 19 degrees was corrected by a mean operative amount of 11 mm, the mean postoperative angles were + 1.5 degrees after one week and - 2.6 degrees after three months with considerable variations of the results (standard deviations were about 5 degrees ). In 15 cases with advancement of the medial rectus muscle the dose-effect relation was 2 degrees per mm operative amount. After three months these patients become more divergent, the mean value was - 6 degrees , the dose-effect relation was reduced to 1.4 degrees /mm. The unilateral recess/resect operations were more constant: these became more divergent of 2.5 degrees only and their dose-effect relation remained more constant (after one week: 1.9 degrees /mm, after 3 months: 1.7 degrees /mm). CONCLUSIONS: The diagnostic value of preoperative prismatic correction of the deviation is very limited. Even if diplopia can be provoked, the chance of disturbing diplopia is very low. Nevertheless, some guidelines for pre- and postoperative care are necessary to prevent double vision. The postoperative outcome is favourable for the patient after one operation. In cases of relapsing divergence a second operation is easily possible.

Adolescent↗
PubMed1998

[Silent sinus syndrome: an unusual cause of vertical diplopia].

BACKGROUND: Causes of transient vertical diplopia include myasthenia, dysthyroid orbitopathy, multiple sclerosis, decompensation of a pre-existing state. PURPOSE: To describe an unusual cause of transient diplopia, silent sinus syndrome. METHODS: Clinical, radiological and pathology findings from a 55-year-old man with acquired transient vertical diplopia are reported. RESULTS: Eight months after onset of symptoms, vertical diplopia was constant. Hypoglobus and enophthalmos were present. On CT scan, orbital floor was thinned and lowered by 8 mm. Maxillary sinus was filled with material compatible with the histological diagnosis of mucocele. Sinus surgery and orbital floor reconstruction resulted in resolution of diplopia. CONCLUSION: Sinus disorders can produce diplopia and/or visual loss, when invading the orbit. Usually, an acute orbitopathy is obvious. Our case shows that chronic sinus disorders can produce "silent" oculomotor disturbances and, at least in the beginning, transient diplopia.

Diplopia↗
PubMed2001

Diplopia after limited macular translocation surgery.

PURPOSE: Full macular translocation surgery relocates the fovea away from choroidal neovascularization, inducing significant postoperative torsional diplopia. In "limited macular translocation," a saline-induced retinal detachment is followed by scleral imbrication with mattress sutures and spontaneous retinal reattachment. In this study, diplopia was characterized in patients treated with limited macular translocation. METHODS: Two surgeons performed retinal translocation surgery on 250 patients over an 18-month time span. The extent and direction of the retinal translocation, and the amount and location of scleral imbrication, were recorded. All patients complaining of diplopia were referred for ocular motility evaluation and treatment. RESULTS: Thirteen (5.2%) patients complained of occasional or constant diplopia. Imbricating sutures were placed supero-temporally in all cases. Inferior foveal translocation ranged from 200 to 2115 microm (median, 1750 microm). Visual acuity ranged from 20/40 to 20/400 in the operated eye. Prism-and-cover testing underestimated the strabismus when compared with subjective testing. In 3 patients, there was no shift on alternate-cover testing despite binocular diplopia. Excyclotorsion ranged from 0 degrees to 16 degrees. Diplopia resolved in 10 cases with prism; 3 required an occlusive filter for distortion or aniseikonia. One patient underwent successful strabismus surgery to eliminate dependence on prism glasses. CONCLUSIONS: Limited macular translocation only rarely produces symptomatic diplopia. Suprisingly, traditional prism-and-cover testing does not reliably quantify the misalignment. This may result from the combination of a persistent macular scotoma and a repositioned fovea relative to the peripheral retina. Prism therapy is generally satisfactory in the absence of retinal distortion or aniseikonia.

Aged↗
PubMed2003

Anaesthesia-related diplopia after cataract surgery.

BACKGROUND: We studied the incidence and clinical characteristics of persistent diplopia related to anaesthesia for cataract surgery in a general hospital. METHODS: This was a retrospective review of anaesthesia for 3587 cataract surgeries. Of all the cases of diplopia referred to the ocular motility clinic after cataract surgery, those involving anaesthesia-related diplopia lasting longer than 1 month were studied. RESULTS: During the study period, 3450 cataract surgeries were performed by phacoemulsification and 137 by extracapsular extraction. Retrobulbar block was used in 2024 cases, peribulbar block in 98, topical anaesthesia in 1420 and general anaesthesia in 43. Twenty-six cases of persistent diplopia were found (0.72% incidence), nine of which (0.25%) were considered to be related to anaesthetic factors; five of the latter involved the left eye. Five were caused by paresis of the inferior rectus muscle and three by fibrosis. In one patient, the inferior oblique muscle was affected. Anaesthesia was by retrobulbar block in eight cases (0.39%) and by peribulbar block in one. No diplopia was found in patients who had topical or general anaesthesia. Treatment was with surgery in two patients and with prisms in six. One patient continues to be studied. CONCLUSIONS: Persistent diplopia can occur after cataract surgery using retrobulbar block predominantly through direct damage to the inferior rectus muscle. The overall incidence of anaesthesia-related diplopia in this series was 0.25%.

Aged↗
PubMed2005

Binocular diplopia. A practical approach.

BACKGROUND: Diplopia is a common complaint in both inpatient and outpatient neurologic practice. Its causes are many, and special historical and examination features are important to localization and accurate diagnosis. REVIEW SUMMARY: This review is divided into 2 sections: the first related to diagnosis and the second to treatment of binocular diplopia. In the diagnostic section, emphasis is placed on identification of historical and examination features that can help to differentiate diplopia caused by dysfunction of cranial nerves versus neuromuscular junction, or orbital extraocular muscle. Techniques available to the neurologist for examining ocular motility and ocular misalignment and focused laboratory testing to evaluate diplopia are discussed in detail. The final section covers the various treatments for binocular diplopia, with recommendations regarding the utility of each treatment for different types of diplopia. CONCLUSIONS: A logical step-by-step approach applied to each patient with diplopia will help prevent misdiagnosis and improve patient care.

Cranial Nerve Diseases↗
PubMedDate not supplied

[Clinical picture and treatment of diplopia].

A total of 203 patients with stable binocular diplopia were observed. Examinations included coordimetry, analysis of double images, and investigation of the doubling field in the gaze field. All examinations were performed using an original method with a serial computer. The treatment included therapy of the underlying disease, choice of correcting prisms, exercises aimed at extension of separate vision field, and operation on the oculomotor muscles. Three main forms of diplopia were distinguished: 1) muscular; 2) sensory; and 3) mixed. The first form includes diplopias in paresis of n.III and n.IV, n.VI, late development of convergent squint, orbital injuries, endocrine ophthalmopathy, and myasthenia. The second form includes diplopias developing after delayed operations for convergent squint, and the third form are diplopias after operations for detachment of the retina and implantation of intraocular lenses. The treatment led to complete neutralization of doubling in 18.7% cases, neutralization in the main part of the gaze field in 53.7%, the same with prism correction in 12.8% cases; in 14.8% patients adaptation to diplopia was attained after suppression of the second image. Diplopia in late squint is prognostically the most favorable, and the following conditions are listed in the order of more or less good prognosis: paresis of n.VI, n.IV, orbital injuries, endocrine ophthalmopathy, and artiphakia. The least favorable prognoses are for patients after delayed operation for squint and detachment of the retina. A new operation, plastic repair of the external m. rectus, was used in 96 patients with pareses of n.VI; no compensation was attained in only 2 patients.

Adolescent↗
PubMed2003

[Is incidence of diplopia after Fat Removal Orbital Decompression a predictive factor of choice of surgical technique for Graves' ophthalmopathy?].

UNLABELLED: Dysthroid orbitopathy or Graves ophthalmopathy is a frequent pathologic condition five times more frequent in females than males. The main symptoms are: proptosis, motility disorders related to eye muscles fibrosis, eyelid retraction, lagophthalmos, and finally the more severe ones: compressive optic neuropathy at the apex of the orbit, and corneal exposure. In order to reduce proptosis the classic approach is Bone Removal Orbital Decompression (BROD) either through eyelid skin, coronal, conjunctival, or endonasal approaches. Recently a new technique has been described by Olivari: Fat Removal Orbital Decompression (FROD). The purpose is to evaluate the incidence of diplopia after FROD and improve surgical indications for Graves' ophthalmopathy. MATERIAL AND METHODS: 35 patients were included in this retrospective study (58 orbits). FROD (OLIVARI technique) was performed in all cases (23 bilateral surgery, 12 unilateral; 12 men, 23 women). All patients with optic neuropathy (severe Graves'ophthalmopathy) were eliminated because bone decompression was always performed. The ocular motility was examined before and after surgery by orthoptic screening. The average follow up was 18 months. RESULTS AND DISCUSSION: Before FROD, 7 patients complained of moderate or severe diplopia: all remained with diplopia after FROD. After FROD 32% developed a new diplopia: only one patient remained with diplopia after strabismus surgery or adaptation by prisms glasses. Diplopia after BROD in moderate Graves' ophthalmopathy (with indications identical to our study) is reported from 23 to 34% in previous studies. CONCLUSION: Diplopia after FROD is a real risk whose incidence is identical after FROD and BROD and must be explained to each patient before surgical decision.

Adipose Tissue↗
PubMed1996

[Clinical significance of diplopia in HIV infection. Assessment of a personal caseload and review of the literature].

Diplopia is one of the neuro-ophthalmic manifestations that can be observed during HIV-infection. The etiologic agents of diplopia in HIV-positive patients can be identified with HIV itself or opportunistic pathogens or other related conditions. We reviewed the clinical records of 13 HIV-positive patients with mono or bilateral diplopia, focusing on etiologic agents, clinical evaluation and prognosis. This review encompassed all cases observed from January 1992 to June 1995 at the Infectious Diseases Department, Policlinico S. Matteo, University of Pavia. All patients underwent a complete ophthalmologic examination, including visual acuity, anterior segment evaluation with biomicroscopy, dilated indirect ophthalmoscopy and ocular motility evaluation (with Cover test and Hess-Lancaster test). If requested by clinical findings, radiologic (TC and/or MRI) and cerebrospinal fluid examination were performed in some patients. The most common causes of diplopia-CNS lesions or ocular diseases-, resulted in agreement with those reported in the literature (T. gondii, C. neoformans, non-Hodgkin lymphomas, HIV, JC virus, CMV). We were able to confirm, according to our experience, that diplopia occurrence is often a negative prognostic factor, since it is commonly associated with CNS conditions. In most cases diplopia can herald a near demise (8 patients on 13 died with 60 days from diplopia onset). In those cases where a treatment was available (2 cases of cryptococcosis, 1 case of neurotoxoplasmosis and 1 case of CMV retinitis) a complete resolution of neuro-ophthalmic symptoms was achieved.

Adult↗
PubMed1998

Binocular vertical diplopia due to subretinal neovascular membrane.

Diplopia is an uncommon finding in patients with subretinal neovascular membranes. We present two patients with binocular diplopia secondary to subretinal neovascular membranes and the foveal displacement syndrome. Subjective diplopia was not improved by prism therapy in either case. In one patient, diplopia was transiently relieved by removal of the choroidal neovascular membrane, but a subsequent subretinal hemorrhage resulted in severe visual loss. In the second patient, diplopia developed following laser therapy for a subretinal neovascular membrane. It is presumed that misalignment of the foveomacular receptor elements between the two eyes produced a central-peripheral fusional mechanism rivalry resulting in binocular diplopia. Ophthalmologists should be aware that a subretinal neovascular membrane may cause binocular diplopia and may mimic neuromuscular strabismus.

Journal Article↗
PubMed1995

Management of diplopia limited to down gaze.

OBJECTIVE: To evaluate the usefulness of various optical and surgical treatment modalities in the treatment of patients who were symptom free in the primary position of gaze yet had symptomatic diplopia in the reading position (down gaze at near). PATIENTS AND METHODS: A retrospective chart review was conducted to identify all patients with presbyopia I have treated who were symptom free in the primary position but had diplopia in down gaze associated with vertically incomitant strabismus. Of 51 patients identified, 32 were symptomatic in down gaze due to a hypertropia associated with a unilateral inferior rectus muscle underaction. Twenty-two of these patients had previously undergone recession of the affected inferior rectus muscle for treatment of thyroid eye disease; four patients, for correction of entrapment secondary to blow-out orbital fracture; and four patients, for treatment of superior oblique muscle palsy. Two patients had undergone prior surgery for superior oblique myokymia. Eight patients had horizontal diplopia associated with an A pattern, and eight patients had horizontal diplopia associated with a V pattern. Three patients had vertical and horizontal diplopia after partial recovery from third-nerve palsy. RESULTS: The treatment modalities were varied and individualized. Treatment consisted of optical management (20 patients), surgical management (21 patients), or a combination of both (10 patients). These treatment modalities resulted in comfortable single binocular vision for reading in 41 of the 51 patients. Successful optical treatment consisted of Fresnel prisms (four patients), slab-off prisms (two patients), single-vision readers (seven patients), switch to nonprogressive bifocal lenses (three patients), and a high bifocal segment (16 patients). Successful surgical modalities included posterior fixation of the contralateral inferior rectus muscle (10 patients), surgery for A- or V- pattern strabismus (five patients), or bilateral inferior rectus muscle recession (six patients). CONCLUSION: Diplopia in the reading position frequently can be alleviated with a systematic approach that includes both optical and surgical modalities.

Adult↗
PubMed1996

Monocular diplopia caused by ocular aberrations and hyperopic defocus.

As a single aperture, approximately monofocal optical system, the human eye generally creates a single image on the retina. However, the literature contains many reports of perceptual monocular diplopia. While it is easy to understand how distortion may produce monocular diplopia, its reported high incidence in normal eyes is less easily understood. We examine a model which ascribes monocular diplopia to an interaction between defocus and ocular spherical aberration. Using a psychophysical hyperacuity-based alignment procedure we measured the transverse aberration function in 0.5 mm steps horizontally across the pupil in the eyes of three cyclopleged subjects. Ocular transverse aberration functions were derived with best refraction and with simulated myopia and hyperopia. Monocular diplopia was also measured under the same conditions. All three subjects showed significant, but different, degrees of positive spherical aberration. The measured ocular transverse aberration functions were predictably modified by the hyperopic and myopic defocus. Hyperopic defocus combined with positive (myopic) spherical aberration changes a monotonic transverse aberration function with a single inflection point into a biphasic function with two inflection points. The locations of the inflections predict the presence and magnitude of the perceived diplopia. These experimental results confirm Verhoeff's (1900) hypothesis for the ocular cause of monocular diplopia.

Adult↗
PubMed2006

Comatic aberration as a cause of monocular diplopia.

Three patients (5 eyes) presented with complaints of monocular diplopia and no history of ocular trauma or surgery. The patients had comprehensive neuroophthalmic evaluation including manifest refraction, anterior segment and dilated fundus examination, and corneal topography. All patients also had wavefront analysis using the LADARWave system (Alcon). Two patients (4 eyes) also had hard contact lens overrefraction. The patients had a normal initial examination including corneal topography. One patient (2 eyes) did not experience resolution of diplopia with pinhole. No eye improved with manifest refraction or hard contact lens overrefraction. However, each patient had a significant amount of coma on wavefront analysis. Moreover, eyes with horizontal diplopia had horizontal coma and eyes with vertical diplopia had vertical coma as measured with the wavefront device. Higher-order optical aberrations such as coma may be associated with monocular diplopia. Wavefront technology may be useful in the workup of monocular diplopia.

Corneal Topography↗
PubMed1998

The incidence of diplopia following coronal and translid orbital decompression in Graves' orbitopathy.

PURPOSE: Firstly, to assess the incidence of induced diplopia following orbital decompression in patients with Graves' orbitopathy. Secondly, to assess patient satisfaction after orbital decompression. Thirdly, to determine the factors that contribute to the variable reported incidence of diplopia complicating decompression surgery. METHODS: We present a retrospective analysis of the alterations of ocular motility in a consecutive series of 81 patients with Graves' orbitopathy who underwent orbital decompression by either a coronal or a translid approach. We assessed patient satisfaction by a telephone survey, and we reviewed the literature. RESULTS: Eleven patients underwent decompressive surgery for dysthyroid optic neuropathy (DON); 5 of them had a three-wall coronal decompression, the other 6 had a two-wall translid decompression. One of the 5 (20%) coronal versus 2 of the 6 (33%) traslid patients experienced worsening of their existing diplopia. Seventy patients underwent surgery for disfiguring proptosis; 41 of them had a coronal decompression and 29 had a translid decompression. Eight of the 41 coronal patients (20%) and 4 of the 29 translid patients (14%) experienced aggravation of their motility impairment. There was no statistically significant difference between these percentages (chi-squared, p > 0.05). Three of 26 coronal patients (12%) without pre-operative motility impairment developed diplopia in all directions. Twenty-five per cent needed strabismus surgery (9% multiple times). High satisfaction scores were noted after both types of orbital decompression. Through a review of the literature, several factors that may add to heterogeneous results were identified, including definition of diplopia, inclusion criteria and type of surgery. CONCLUSIONS: Induced diplopia is seen after any type of orbital decompression (19% overall), and its incidence is determined by various factors. To facilitate comparative studies between decompression techniques, a standardised protocol for orthoptic evaluation should be developed.

Adult↗
PubMed2006

Causes and outcomes for patients presenting with diplopia to an eye casualty department.

PURPOSE: To evaluate the causes and outcomes for patients presenting with diplopia to an eye casualty department. METHODS: Patients presenting with diplopia as a principal symptom, who were referred to the Orthoptic Department from Moorfields Eye Casualty over a 12-month period, were retrospectively investigated. RESULTS: One hundred and seventy-one patients were identified with complete records in 165 cases. There were 99 men and 66 women with an age range of 5-88 years. Monocular diplopia accounted for 19 cases (11.5%), whereas 146 patients (88.5%) had binocular diplopia. Cranial nerve palsies were the most common cause of binocular diplopia accounting for 98 (67%) of cases. Isolated sixth nerve palsy was the largest diagnostic group (n=45). Microvascular disease (hypertension or diabetes mellitus, or both) was present in 59% of patients with cranial nerve palsies, and of this group, 87% resolved spontaneously by 5 months rising to 95% by 12 months. CONCLUSION: Patients with clinically isolated single cranial nerve palsies associated with diabetes or hypertension are likely to recover spontaneously within 5 months and initially require observation only. However, patients with unexplained binocular diplopia and those who progress or fail to recover should be investigated to establish the underlying aetiology and managed as appropriate.

Adolescent↗
PubMed2002

Reduction of diplopia following endoscopic orbital decompression: the orbital sling technique.

OBJECTIVE: Although endoscopic orbital decompression has become the surgical treatment of choice for patients with proptosis from Graves disease, postoperative diplopia requiring corrective eye muscle surgery can occur in up to 63% of patients. The purpose of the study was to evaluate a new technique intended to reduce the incidence of diplopia following endoscopic orbital decompression. STUDY DESIGN: Case-control. METHODS: Endoscopic orbital decompression was performed on 58 orbits in 37 patients with proptosis from Graves disease. The orbital sling technique, which makes use of a horizontal strip of periorbital fascia to prevent prolapse of the medial rectus muscle, was used on 20 orbits in 13 patients. Conventional endoscopic decompression was performed in 24 control subjects. The mean duration of follow-up was 3.3 +/- 1.3 years (range, 1.7-5.1 y). RESULTS: The incidence of new-onset or worsened diplopia following endoscopic decompression was significantly lower for the orbital sling group compared with control subjects (0% vs. 29.2%, respectively [ =.038]). No patients in the orbital sling group developed new-onset diplopia following surgery. Of the eight patients with pre-existing diplopia from the orbitopathy, double vision improved in four patients (50%) and was unchanged in the remaining four patients (50%). The mean reduction in proptosis was comparable for the orbital sling and control groups (5.1 +/- 1.1 mm vs. 5.0 +/- 1.9 mm, respectively [ P=.98]). CONCLUSIONS The preservation of a fascial sling overlying the medial rectus muscle during endoscopic orbital decompression appears to reduce the incidence of postoperative diplopia, while still allowing for a satisfactory reduction in proptosis. This modification of the standard decompression technique should be considered for the treatment of patients with proptosis.

Adult↗