Download Coat Hanger Trauma – A novel presentation of IR transection

Coat Hanger Trauma: A novel presentation of IR transection
Saurabh Jain1, Radhika Rampat1, Ankur Gupta1
¹ Department of Ophthalmology, Royal Free Hospital, London, UK
Correspondence: [email protected]
History: A 30-year-old Caucasian man suffered a traumatic
Presentation
complete inferior rectus (IR) transection resulting in a right
hypertropia. The injury was secondary to a coat hanger stuck
in a bed frame catching his right eye whilst bending down,
which the patient then immediately pulled out.
Clinical findings: On presentation there was constant
vertical diplopia with a 20 dioptre right hypertropia in primary
gaze which increased to 45 dioptres in limited down gaze. The
distal 1cm of the muscle was visibly protruding from the
conjunctival traumatic incision. The rest of the ocular
examination was unremarkable, with no associated orbital
fracture.
Management: A primary repair of the IR was carried out
the same day
References:
Ludwig IH, Brown MS. Strabismus due to flap tear of a rectus
muscle. Trans Am Ophthalmol Soc 2001;99:53-63.
2 weeks post-op
Conclusion: There is
no consensus on the timing
of surgery at the moment
however our case supports
the existing limited data
that a timely repair results
in an improved outcome
[1,2]. Early repair in this
scenario is critical and can
lead to an excellent
outcome, as demonstrated.
Outcome: After three
months of follow up, he
remains asymptomatic with
no deviation in primary
gaze, and only a slight
residual limitation of right
downgaze measuring 10
dioptres right over left.