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Ocular Motility Disorders and Orbital Trauma

Orbital trauma is a common occurrence in our highly mechanized and, at times, violent world. Such injuries occur as a result of trauma specifically intended to inflict injury, such as war or violent altercations, as well as arising as a consequence of work, transportation, recreation and, occasionally, surgical intervention. Orbital trauma may occur in isolation or in association with other injuries to the head, neck, or body. Ocular motility disorders are a common consequence of orbital trauma and frequently cause significant disability from sensory abnormalities as well as disfigurement. Diplopia is the most common and incapacitating sensory complaint in adults. Ocular motility disorders that occur during childhood may also cause profound abnormalities in the developing visual system. The reestablishment of single binocular vision is a major therapeutic goal. The mechanisms responsible for posttraumatic ocular motility disturbances are often complicated, with abnormalities affecting multiple orbital tissues as well as contiguous structures. Orbital trauma commonly alters the elastic properties of the extraocular muscles as well as other orbital tissues, causing restriction of eye movements. In addition, the contractile abilities of the extraocular muscles may be reduced directly through muscle injury or indirectly by nerve injury. Recent advances in our understanding of the neural control mechanisms responsible for eye movements as well as quantitative approaches to the mechanics of ocular motion have provided substantial insight into ocular motility disorders that occur following orbital trauma. Remarkable new imaging techniques reveal the structural changes that are caused by orbital trauma and have greatly enhanced the precision of diagnostic evaluation. New surgical techniques have expanded the available therapeutic options and improved results. Despite these advancements, the evaluation and management of ocular motility disorders caused by orbital trauma remain a significant challenge to the ophthalmologist. Unfortunately, therapy sometimes fails to provide