| OCR Text |
Show Journal of Neuro- Ophthalmology 17( 3): 194, 1997. © 1997 LippincoU- Ravcn Publishers, Philadelphia Images Dentist's Diplopia Gregory S. Kosmorsky, D. o. A 32- year- old woman underwent correction of a right-sided temporomandibular joint dysfunction. Before the surgery she had been visually asymptomatic. Immediately after the operation she noted horizontal diplopia that was worse on right gaze. On clinical examination she was found to be 20/ 15 in each eye. She had no afferent pupillary defect. Her external and slit lamp examinations were normal. The salient feature of the examination was the presence of a complete right abduction defect. Forced duction testing was free, suggesting a neural cause for her diplopia. However, an orbital MR scan revealed that the right orbital wall had been violated surgically, as evidenced by FIG. 1. Axial MR scan demonstrating the presence of orbital fat in the temporal fossa. From the Division of Ophthalmology, Cleveland Clinic Foundation, Cleveland, Ohio 44195. Address correspondence and reprint requests to Dr. Gregory S. Kosmorsky, Division of Ophthalmology, A- 31 Cleveland Clinic Foundation, 1 Clinic Center Drive, Cleveland, OH 44195- 5024. the fact that orbital fat could be seen protruding into the temporal fossa ( Fig. 1). Additionally, the lateral rectus muscle was found to be discontinuous ( Fig. 2). Violation of the confines of the bony orbit usually occurs in the setting of nasal surgery where the thin nasal lamina paprycea is easily penetrated. Penetration of the lateral wall of the orbit is a distinctly unusual event and likely requires substantial force. The lateral rectus muscle probably was extirpated or transected by a sharp instrument. Surgical correction of the esotropia was offered but declined by the patient. She patches her right eye to avoid diplopia. FIG. 2. Axial MR scan demonstrating discontinuity of the right lateral rectus muscle. 194 |
