Pediatric emergency medicine trisk 0600 0600
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TABLE 28.4
LIFE-THREATENING CAUSES OF STRABISMUS a
Intracranial mass
Elevated intracranial pressure
Myasthenia gravis
Orbital tumor
Orbital cellulitis
a Not
Head trauma
Neoplastic infiltration of extraocular muscles
Meningitis
Superior orbital wall fracture
Retinoblastoma causing visual loss
listed in order of frequency.
Esotropia following orbital trauma may be due to lateral rectus injury,
hemorrhage, and medial or lateral wall fracture. Fracture of the medial orbital
wall may cause entrapment and restriction of the medial rectus. Fracture of the
lateral wall—usually part of a tripod fracture that involves the zygoma and
inferior lateral wall—may cause orbital hemorrhage that would displace the eye
medially.
The presence of proptosis suggests an orbital process. A lateral orbital tumor or
abscess can push the eye toward the nose or restrict abduction. Any infiltrative
process that involves the eye muscles may also cause esotropia through
restriction. Orbital cellulitis, with or without abscess formation, can cause any
type of misalignment including esotropia. A contrast CT scan of the orbit with
coronal and axial views is the diagnostic procedure of choice in these situations.
