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Answers: 2004 series -  February 10, 2004 Lecture 47 of 50  NEXT»

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This 11-year-old boy fell off a horse when he was 6 and was struck in the left eye with a stick.  He has had no treatment.  He has no symptoms and is bothered only by the diplopia.  He comes to you for help: 

1.  The work-up should include:

-- All of the above are necessary to evaluate this child for further treatment.  The degree of superior rectus function along with assessment of any restrictions will be necessary information to have in planning muscle surgery.  This should be done before attempts at ptosis repair.  An experienced surgeon confident that the muscle surgery would be successful could undertake ptosis repair at the initial procedure.

2.  The most likley diagnosis is:

-- The history, findings and left upper lid scar point to a diagnosis of traumatic left levator palpebri and left superior rectus traumatic disruption.
3.  A logical treatment plan would include:

 -- Levator repair will be necessary.  This could simply mean repair of a functioning levator that has had disruption of the levator aponeurosis or damage to the levator muscle.  If no or limited levator muscle function is suspected, resection of the levator muscle may be required.  The levator function should be carefully assessed before surgery.  Evidence of a contracting levator muscle shown by deepening of the upper lid sulcus on up gaze would indicate the need for aponeurosis repair and/or levator advancement.  Depending on forced ductions and generated force some form of vertical muscle recess-resect would be indicated.  It is unlikely that muscle transfer would be needed.

Lecture 47 of 50 «Previous Lecture   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50    Next»