A Case of Traumatically Ruptured Medial and Inferior Rectus Muscles with an Avulsed Optic Nerve

Young Jin Kim; Sung Hyuk Moon

doi:10.3341/jkos.2016.57.10.1666

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Kim and Moon: A Case of Traumatically Ruptured Medial and Inferior Rectus Muscles with an Avulsed Optic Nerve

Case Report

J Korean Ophthalmol Soc 2016;57(10):1666-1670.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.10.1666

A Case of Traumatically Ruptured Medial and Inferior Rectus Muscles with an Avulsed Optic Nerve

Young Jin Kim, MD^1,², Sung Hyuk Moon, MD, PhD^1,²

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Sung Hyuk Moon, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329 E-mail: Koils79@naver.com

Received 16 June 2016 Accepted 24 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the good surgical results of multiple ruptured rectus muscles with avulsion of the optic nerve.

Case summary

A 39-year-old male patient underwent surgical exploration after rupture of the inferior and medial rectus muscles and avulsion of the optic nerve. The disinserted muscles were attached at the primary insertion site, and a served optic nerve was not found. Six months after the injury, the patient had orthotropia in the primary position without ischemia of the anterior segment.

Conclusions

In rare instances, blunt trauma can result in optic nerve avulsion with ruptured inferior and medial rectus muscles. Surgical treatment can result in a favorable outcome.

Keywords: Extraocular muscle, Optic nerve avulsion, Trauma

References

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Figure 1.

External photograph of eyeball. (A) The pupil was fixed and dilated. (B) A conjunctival laceration and the stump of ruptured inferior and medial rectus muscle was seen. (C) The right eye was fixed in extreme abduction and supraduction. There was no adduction on attempted left gaze and no infraduction on attempted down gaze. (D) The completely severed optic nerve is visible (black arrow).

Figure 2.

Computed tomography image and external photograph of eyeball. (A, B) The facial bone computed tomography image showed a ruptured optic nerve at the intraorbital insertion site (white arrow). (C, D) Examination under anesthesia revealed a completely severed optic nerve (black arrow), complete disinsertion of the medial (black arrowhead) and inferior rectus muscles (white arrowhead).

Figure 3.

Nine postoperative positions of gaze 6 months after the operation. Improved abduction and supraduction of the right eye was noted.

Figure 4.

Anterior segment photograph. Twelve months after the operation, there was mild corectopia, but no corneal edema, anterior chamber reaction, or rubeosis iridis was seen.

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