|Year : 1981 | Volume
| Issue : 2 | Page : 115-116
Traumatic disinsertion of medial rectus muscle
PT Lemade, SC Karandikar, SP Vaijwade, Sunaina Ahuja
Department of Ophthalmology, Medical College, Aurangabad, India
P T Lemade
Department of Ophthalmology, Medical College, Aurangabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lemade P T, Karandikar S C, Vaijwade S P, Ahuja S. Traumatic disinsertion of medial rectus muscle. Indian J Ophthalmol 1981;29:115-6
Injuries involving the eye and the orbit are of day to day occurrence, although the extraocular muscles are involved less frequently. Many varied accidents can cause muscle injury. Perforating injury causing tear in the muscle is quite rare. The purpose of this paper is to record this rarity.
| Case report|| |
A 36 years old male was admitted in Ophthalmic ward with the history of a fall on bicycle handle four days back.
On local examination the patient had vertical tear in the left lower lid. The head. was turned to the right side. The left eve was exotropic by 30°, with complete restriction of adduction, rest of the movements being normal [Figure - 1]. The diplopia was maximum on dextroversion. The Hess screen test revealed weakness of left medial rectus with marked overaction of right lateral rectus muscle. Pupil was normal. The visual acuity in both eyes was 6/6. Fundus examination revealed no abnormality.
On exploration under surface anaesthesia, there was found to be a through and through tear in the left lower lid involving the lacrimal canaliculus. There was a band of adhesion in between the medial part of the lid and the sclera. The eye could not be adducted even after severing this fibrous band and freeing the eye ball. Further operation was then carried out after retrobulbar anaesthesia. There was a granulomatous mass on the sclera at the site of insertion of medial rectus muscle. The medial rectus muscle was dissected. The inferior 4/5th of the muscle was detached from its insertion and the superior 1 /5th was in place. The muscle was bifurcated for 10 mm. in its long axis. The granulomatous mass was excised. It was containing no foreign body. The muscle was sutured at its original site. The conjunctiva was sutured. No surgical intervention was done for lacrimal canalicular tear.
The post-operative course was uneventful except for diplopia which lasted for five days. The head posture became normal. There was no heterotropia and movements were normal [Figure - 2]. The Hess screen test and the diplopia test were showing no defect.
| Discussion|| |
The concussion injuries involve the muscles commonly. Nevertheless, the perforating injury do tear the muscle. Different objects injuring the muscles are on record. Single muscle or a group of muscles may be involved in such injuries. The muscle tendon or the muscle be torn across completely or partially. When the muscle is completely disinserted it inveriably retracts and then it is difficult to find the muscle. The medial rectus muscle may be injured alone or alongwith other muscles. These other muscles are either levator palpebrae superioris, or inferior rectus.
In the present case, only the medial rectus muscle was involved and it was partially disinserted. It was easily identified and successfully sutured. The prognosis is usually good after surgical repair.
| Summary|| |
A case of perforating injury with a bicycle handle involving the medial rectus muscle disinsertion is reported for its rarity.
| References|| |
Duke Elder, S., 1972, System of Ophthalmology, Vol. XIV, Page 441, Henry Kimpton, London.
[Figure - 1], [Figure - 2]