Management of Direct Extraocular Muscle Trauma

Injuries caused by direct extraocular muscle (EOM) trauma can be devastating to the binocular visual functioning in our patients. Whether traumatic or iatrogenic, whether resulting in partial loss of function, mechanical restriction, or complete muscle loss, EOM trauma causes incomitant strabismus that can be difficult, if not impossible, to completely correct. The EOM injury and resulting incomitant diplopia can result in temporary or even permanent handicaps including inability to function in one's job, in sports, or even in common tasks of daily living, such as driving.When extraocular muscle trauma is iatrogenic, it can be especially difficult for the involved ophthalmologist, both emotionally and legally. Nevertheless, most ophthalmologists, especially those who specialize in strabismus, will be confronted with this problem during their careers and therefore a proper understanding of its diagnosis, and optimal management, is essential. This paper will discuss, based on the author's personal experience and literature review, the common causes for extraocular muscle trauma and appropriate treatment strategies to restore maximum binocular vision potential and eliminate diplopia. The clinical pearls most useful in daily practice will be emphasized. It is hoped that this information will assist others in the optimal care of these challenging patients.