Dr. Ankita Mulchandani, Dr. Narayan Alane, Dr. Mehul A. Shah, Dr. Shreya Shah, Dr. Anand Tibdewal

1. • FP-0799: PURE EXTRAOCULAR
MANIFESTATIONS OF BLUNT TRAUMA
DR. ANKITA MULCHANDANI DR.ANJALI ISRANI
DR. MEHUL SHAH DR.SHREYA SHAH
THE AUTHORS HAVE NO FINANCIAL INTERESTS TO DISCLOSE.
TOKEN NO:0348 :PURE
EXTRAOCULAR MANIFESTATIONS
OF BLUNT TRAUMA
Dr. ANKITA MULCHANDANI Dr. NARAYAN ALANE
Dr. MEHUL A. SHAH Dr. SHREYA SHAH
DR. ANAND TIBDEWAL
THE AUTHORS HAVE NO FINANCIAL INTERESTS TO DISCLOSE.

2. INTRODUCTION
• Trauma is a known cause of monocular
blindness.
• Ocular trauma may affect lacrimal canaliculi,
extraocular muscles , or intraocular structures
and present in a variety of ways.
• Blunt trauma may present with only
extraocular manifestations.

3. • Lid lacerations are common with ocular
injuries,[1,2] while an association with
lacrimal passage injuries is less common.[1]
• The traumatic rupture of extra-ocular muscles
is rare.
• We observed all three injuries in one patient
and successfully repaired the conjunctiva,
lacrimal canal, inferior rectus muscle, during
a single procedure.

4. CASE REPORT
• A 25 year old male presented to our outpatient department
following an injury to the lid of his left eye (OS), caused by
an iron rod.
On examination,
• Vision (Os)- 6/6
• Hypertropia
• Inability To Move Downwards
• Injury To The Lower Lid Involving The Lacrimal Canal
(Fig-1.)
• A Tear In The Conjunctiva
• Ruptured Inferior Rectus Muscle (Fig-3.).
• Hypertropia Of The Os And Absent Inferior movement in the
affected eye.

5. • The eyelid was repaired surgically in layers
considering grey line .
• The ruptured lacrimal canal was repaired using
the Teflon sleeve of a 22G Intracath (Fig-2.),
which was left in place for 6 weeks.
• We located the proximal end of the canal and
confirmed it by syringing.
• We found the proximal end of the inferior rectus
muscle and sutured it to the distal end, achieving
proper strength, as detected by orthophoria in the
primary position and inferior movements at the
end of the repair (Fig-2.).

6. Fig 1 • Lower lid tear
involving proximal
and distal canaliculus.
Fig 2
• Ruptured lacrimal
canal repaired with
Teflon sleeve which
was left in place for 6
weeks

7. Fig 3
• Conjunctival tear being
sutured.
• Promixal and distal ends of inferior rectus being
sutured.
Fig 4

8. • Patient was treated with local and systemic
antibiotics and corticosteroids post operatively.
• The patient complained of diplopia in the early
postoperative period.
• This was evaluated with diplopia charts and the
patient improved slowly, both subjectively and
objectively.
• The patient achieved orthophoria and full
movement in inferior gaze.

9. Discussion:
•Lid lacerations and repair have been reported, with or
without involvement of the lacrimal canal.
• However, a laceration involving the lid, lacrimal canal,
and extra-ocular muscle is unique and the successful repair
of all components during a single procedure has not been
reported.
•Lacrimal canal lacerations are common in ophthalmic
practice, but direct injury to the canal is reported only in
16% to 54% [7] of cases.

10. Discussion:
• Variable success rates have been reported for lacrimal
canal repair using different techniques, including a pig tail
needle [2] or silicon tube for intubation, or a mini-
monoka.[5]
• There are few reports on the rupture of extra-ocular
muscles.[4-7] Rupture of the inferior rectus has been
reported in three studies.[4,7], Harish et al. reported rupture
of the superior oblique,[7] while Sari et al. reported the
rupture of three rectus muscles in blunt trauma.[6]

11. Conclusion:
• An extra-ocular injury involving the
conjunctiva, lid, lacrimal passages, and extra-
ocular muscles can be repaired successfully
during a single procedure.

12. References:
1) Lima-Gómez V, Mora-Pérez E Ocular lesions associated with lid
wounds with or without tear duct affection Cir Cir.2006 ;74:11-
4.[Article in Spanish]
2) Walter WL. Ophthalmic Surg. The use of the pigtail probe for
silicone intubation of the injured canaliculus.1982;13:488-92.
3) Naik MN, Kelapure A, Rath S, Honavar SG Management of
canalicular lacerations: epidemiological aspects and experience with
Mini-Monoka monocanalicular stent. Am J Ophthalmol.2008 ;
145:375-380.
4) Sari A, Adiguzel U, Ismi T. An unexpected outcome of blunt ocular
trauma: rupture of three muscles. Strabismus 2009; 17:95-7.
5) .Harish AY, Ganesh SC, Narendran K. Traumatic superior oblique
tendon rupture. J Aapos 2009;13:485-7.
6) O'Toole L, Long V, Power W, O'Connor M. Traumatic rupture of
the lateral rectus. Eye (Lond) 2004;18:221-2
7) Ling R, Quinn AG. Traumatic rupture of the medial rectus muscle. J
Aapos 2001 ;5:327-8.