Surgery for traumatic strabismus

Various mechanical trauma to the head or eye can directly or indirectly damage the extraocular muscles and their innervated nerves, causing muscle breakage or paralysis, clinically manifested as traumatic paralytic oblique strabismus (traumutic paralytic strabismus) ). Early exploration or late correction according to different conditions. Curing disease: Indication 1, early surgery (1) Fresh sharp injuries and serious eye movements. (2) Muscle breakage or complete paralysis. The criteria for judging complete muscle rupture or paralysis: one is that the eye movement cannot pass the midline, and the other is that the SEM examination has a gliding motion that is 20% lower than normal. 2, late surgery extraocular muscle injury after treatment with drugs for more than half a year, strabismus did not improve, and greater squint with the prism can not neutralize the double vision. Contraindications 1. Patients with extraocular muscle dysfunction can not undergo early surgery. 2, with conservative treatment, the strabismus continues to improve. 3, the squint is smaller with the prism can completely eliminate the double vision. Surgical procedure 1, early exploration If the local reaction of the eye is not severe after trauma, the exploration should be performed as soon as possible. Such as local edema, hyperemia and suspected infection should first use drugs to control inflammation before exploration. (1) Method of finding muscles: first cut the conjunctiva at the end of the suspected broken muscle, and use the squint hook to find the muscle along the surface of the sclera. Hook the end of the muscle to prove that the muscle is broken. If the muscle has broken, the suspicious muscle can be grasped by the toothed scorpion, and the patient can turn the eyeball in the direction of the muscle action. If there is a pulling sensation or a muscle twitch caused by electrical stimulation, the muscle has been found. If you can't grasp the muscle, you can use the conjunctival wound irrigation method or a few drops of 2.5% phenylephrine adrenal gland to find the muscle structure of the pale structure. (2) After the muscle was found, the end-to-end intermittent suture was performed with 6-0 absorbable suture. (3) When the muscle is not found, the suspicious muscle sheath or the cord tissue containing the muscle fiber can be sutured back to the end of the muscle, and the rectus muscle transposition can be performed at the same time or in stages. 2, advanced surgery Detailed examination should be performed before surgery, and the speed of saccade should be examined by pulling test and SEM to confirm that the oblique is regarded as restrictive or paralyzed, and then the surgical plan is developed. (1) Due to the restrictive strabismus caused by adhesion, the adhesion should first be removed, and then the rectus muscle displacement or coupling should be performed as appropriate (see "straight muscle transposition" and "straight muscle coupling"). (2) If the palsy muscle still has some functions, you can do antagonism after the muscle migration, and if necessary, do the rectus muscle displacement or the joint surgery.