What is the surgical treatment for diplopia?

Updated: May 21, 2019
  • Author: Jitander Dudee, MD, MA(Cantab), FACS, FRCOphth; Chief Editor: Andrew G Lee, MD  more...
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Answer

Strabismus surgery is occasionally necessary. [12] The typical recession/resection is rarely indicated due to the one muscle often being permanently weak, and any standard surgery will lose effect over time. Exceptions include a blow-out fracture when the release of the entrapped soft tissues from the fracture in the floor of the orbit can be very effective.

Transposition surgery (Hummelsheim surgery): With permanent paralysis of the lateral rectus muscle, overcoming the unopposed tone of the medial rectus muscle is possible by splitting the superior and inferior recti muscles and by reinserting the lateral half of each muscle at the lateral rectus insertion. Otherwise, any recession of the medial rectus muscle will be of only temporary benefit. Despite achieving single vision straight ahead, the diplopia will persist with gaze toward the paralytic muscle.

Knapp superior oblique muscle paralysis: With permanent weakness of the superior oblique muscle, it is possible to weaken the yoke muscle of the opposite eye (superior rectus muscle) as well as the direct antagonist (inferior oblique muscle) in the same eye, together with a shortening of the affected muscle, to minimize the deviation.

Chemodenervation [12] : This helps prevent the contracture in eyes with extraocular muscle paresis, especially when return of function is expected. Multiple injections over several months of botulinum toxin into the medial rectus muscle reduce contracture due to a weak lateral rectus from a sixth nerve paralysis. The effect may be more permanent than expected; the opposing un-injected muscle may develop a degree of permanent shortening and contracture.


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