Green Elspeth, Harwood Hannah, Bansal Shveta
Manchester Royal Eye Hospital, GB.
Royal Preston Hospital, GB.
Br Ir Orthopt J. 2021 Apr 15;17(1):79-84. doi: 10.22599/bioj.165. eCollection 2021.
We describe a rare case of cyclotorsion likely secondary to medial rectus and inferior rectus pathology in a patient with orbital trauma. Sequential orthoptic measurements including Hess charts are presented alongside relevant sections of the orbital CT scans over the course of the patient's treatment. Following the insertion of a plate to repair an orbital floor fracture, the patient developed cyclotorsion. A combined approach of sequential orthoptic assessment and imaging revealed the likely underlying mechanism. Inferior rectus mechanical restriction combined with displacement of the medial rectus pulley appear to be the likely culprits. Once the orbital plate was exchanged for a smaller sized plate the patient's symptoms and clinical features resolved. Although orbital plate malpositioning is not an uncommon event, medial rectus deviation as a cause of cyclotorsion has not previously been described. We discuss the alternative differentials for patients with similar orthoptic findings and how they were excluded.
我们描述了一例罕见的旋转性斜视病例，可能继发于一名眼眶外伤患者的内直肌和下直肌病变。在患者治疗过程中，展示了包括Hess图表在内的系列视光学测量结果以及眼眶CT扫描的相关部分。在插入一块修复眶底骨折的钢板后，患者出现了旋转性斜视。系列视光学评估与影像学相结合的方法揭示了可能的潜在机制。下直肌机械性受限与内直肌滑车移位似乎是可能的病因。一旦将眶板换成尺寸较小的钢板，患者的症状和临床特征就消失了。虽然眶板位置异常并不罕见，但内直肌偏斜作为旋转性斜视的病因此前尚未见报道。我们讨论了具有类似视光学检查结果的患者的其他鉴别诊断以及如何排除这些诊断。
