Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Globe Retraction Treatment & Management

  • Author: Michael T Yen, MD; Chief Editor: Andrew G Lee, MD  more...
 
Updated: Mar 15, 2016
 

Approach Considerations

Treatment should be directed at the underlying etiology.

Next

Medical Care

Duane retraction syndrome [1] ​ [2, 14, 15]

Correct refractive errors and treat amblyopia if present.

Patient can be kept under observation if there is no significant strabismus in primary gaze, anomalous head position, cosmetically unacceptable upshoots/downshoots, or globe retraction.

Orbital blowout fracture [4, 5, 6]

Patients should avoid nose blowing.

Oral antibiotics and nasal decongestants should be prescribed.

Cold compresses can be used to reduce eyelid edema to facilitate follow-up examinations.

Metastatic carcinoma [7, 8, 13, 9]

Patients should undergo appropriate systemic screening to identify primary tumor.

Orbital radiotherapy and/or systemic chemotherapy should be considered.

Previous
Next

Surgical Care

Goals for surgery in Duane retraction syndrome include correction of ocular alignment in primary gaze, elimination of any abnormal head position, reduction of magnitude of upshoots/downshoots, and globe retraction, as follows:[1]

  • Recession of ipsilateral medial rectus in type I when esotropia is less than 30 prism diopters
  • Bilateral medial rectus recession in type I when esotropia is greater than 30 prism diopters
  • Recession of ipsilateral lateral rectus muscle in type II
  • Never perform rectus resection because this is likely to increase globe retraction.
  • Recession of both horizontal recti to reduce globe retraction
  • Splitting of lateral rectus in a Y configuration or using posterior fixation sutures on the lateral rectus may reduce upshoots.

Orbital blowout fractures should be repaired if there is obvious entrapment of an extraocular muscle, no improvement in diplopia, or unacceptable enophthalmos.[5] Autogenous or allogenic bone, demineralized bone, hydroxyapatite, and synthetic implants (eg, Teflon, Silastic, Supramid, porous polyethylene) may be used to repair the fracture. Surgical management of orbital and periorbital trauma may require cooperative efforts from otolaryngology and neurosurgery.

Previous
Next

Consultations

See the list below:

  • Strabismus surgeon for extraocular muscle surgery in Duane retraction syndrome
  • Orbital surgeon for repair of blowout fractures
  • Oncologist and radiation oncologist for management of metastatic carcinoma
Previous
Next

Activity

Patients with orbital blowout fractures should have limited activity.

Avoidance of Valsalva maneuver and blowing of nose is crucial to reduce probability of developing orbital emphysema.

Previous
 
 
Contributor Information and Disclosures
Author

Michael T Yen, MD Professor of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Medical Director, Alkek Eye Center, Co-Director, BCM Aesthetics, Program Director, ASOPRS Fellowship, Baylor College of Medicine

Michael T Yen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Andrew G Lee, MD Chair, Department of Ophthalmology, Houston Methodist Hospital; Clinical Professor, Associate Program Director, Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch; Clinical Professor, Department of Surgery, Division of Head and Neck Surgery, University of Texas MD Anderson Cancer Center; Professor of Ophthalmology, Neurology, and Neurological Surgery, Weill Medical College of Cornell University; Clinical Associate Professor, University of Buffalo, State University of New York School of Medicine

Andrew G Lee, MD is a member of the following medical societies: American Academy of Ophthalmology, Association of University Professors of Ophthalmology, American Geriatrics Society, Houston Neurological Society, Houston Ophthalmological Society, International Council of Ophthalmology, North American Neuro-Ophthalmology Society, Pan-American Association of Ophthalmology, Texas Ophthalmological Association

Disclosure: Received ownership interest from Credential Protection for other.

Additional Contributors

Gerhard W Cibis, MD Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas School of Medicine

Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Ophthalmological Society

Disclosure: Nothing to disclose.

References
  1. Britt MT, Velez FG, Thacker N, Alcorn D, Foster RS, Rosenbaum AL. Surgical management of severe cocontraction, globe retraction, and pseudo-ptosis in Duane syndrome. J AAPOS. 2004. 8:362-367. [Medline].

  2. Chua B, Johnson K, Donaldson C, Martin F. Management of Duane retraction syndrome. J Pediatr Ophthalmol Strabismus. 2005. 42:13-17. [Medline].

  3. Athanasiov PA, Prabhakaran VC, Selva D. Non-traumatic enophthalmos: a review. Acta Ophthalmol. 2008 Jun. 86(4):356-64. [Medline].

  4. Cepela MA, George CE. Orbital trauma. Curr Opin Ophthalmol. 1997 Oct. 8(5):64-9. [Medline].

  5. Putterman AL, Smith BC, Lisman RD. Blowout fractures. In: Nesi FA, et al, eds. Smith's Ophthalmic Plastic and Reconstructive Surgery. 2nd ed. 1998:209-23.

  6. Remulla HD, Bilyk JR, Rubin PA. Pseudo-entrapment of extraocular muscles in patients with orbital fractures. J Craniomaxillofac Trauma. 1995. 1:16-29. [Medline].

  7. Goldberg RA, Rootman J. Clinical characteristics of metastatic orbital tumors. Ophthalmology. 1990 May. 97(5):620-4. [Medline].

  8. Rootman J, Ragaz J, Cline R, et al. Tumors: Orbital metastasis. In: Rootman J, ed. Diseases of the Orbit. 1988:405-26.

  9. Tijl J, Koornneef L, Eijpe A, et al. Metastatic tumors to the orbit--management and prognosis. Graefes Arch Clin Exp Ophthalmol. 1992. 230(6):527-30. [Medline].

  10. Alsuhaibani AH, Carter KD, Nerad JA, Lee AG. Prostate carcinoma metastasis to extraocular muscles. Ophthal Plast Reconstr Surg. 2008 May-Jun. 24(3):233-5. [Medline].

  11. Mombaerts I, Goldschmeding R, Schlingemann RO, Koornneef L. What is orbital pseudotumor?. Surv Ophthalmol. 1996 Jul-Aug. 41(1):66-78. [Medline].

  12. Strachan IM, Brown BH. Electromyography of extraocular muscles in Duane''s syndrome. Br J Ophthalmol. 1972 Aug. 56(8):594-9. [Medline].

  13. Shields CL, Shields JA. Metastatic tumors to the orbit. Int Ophthalmol Clin. 1993 Summer. 33(3):189-202. [Medline].

  14. Khan AO, Aldamesh M. Bilateral Duane syndrome and bilateral aniridia. J AAPOS. 2006 Jun. 10(3):273-4. [Medline].

  15. Oohira A, Masuzawa K. A case of congenital oblique retraction syndrome with upshoot in adduction. Strabismus. 2002. 10:39-44. [Medline].

Previous
Next
 
Patient presented with persistent diplopia after an interpersonal altercation. Forced ductions revealed tight inferior and medial rectus muscles on right side. CT scan revealed orbital floor and medial wall fractures in right orbit.
Patient with metastatic breast carcinoma to the intraconal space of the right orbit resulting in mild globe retraction and enophthalmos.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.