Extraocular Muscle Trauma: Clinical Approach to Diagnosis and Surgical Management of Rectus Muscle Disruptions

Abstract

We aimed to review the clinical approach to diagnos and surgical management of traumatic extraocular rectus muscle disruptions, a rare but significant cause of strabismus and diplopia in the adult trauma patients. This review examined the anatomy of the four rectus muscles, mechanisms of injury, clinical presentation, imaging evaluation, classification of injury types, management strategies, outcomes, and future directions in treatment. Extraocular rectus muscle disruptions occur through blunt trauma (typically causing muscle entrapment in the orbital fractures) or penetrating trauma (causing laceration or avulsion). Clinical features include diplopia, restricted eye movement, and in some cases, visible muscle prolapse. Imaging evaluation includes computed tomographyas first-line approach, with magnetic resonance imaging providing superior soft tissue detail, and anterior segment optical coherence tomography offering valuable information for surgical planning. Management focuses on early intervention, with surgical repair ideally performed within 24-48 hours for entrapped muscles and within days for lacerations or avulsions. Outcomes vary based on injury severity and timing of treatment, with better prognosis associated with early intervention. While traumatic extraocular rectus muscle disruptions present complex challenges, prompt diagnosis and surgical management often yield favorable results. Future advances in treatment might involve advanced imaging techniques, engineered tissue for muscle reconstruction, refined surgical approaches, and improved interdisciplinary trauma care protocols.

Keywords: Diplopia; Extraocular muscles; Muscle avulsion; Orbital trauma; Strabismus.