Orthoptic Vision Therapy: Establishing a Protocol for Management of Diplopia Following Orbital Fracture Repair

Brandon J. De Ruiter, Vikas S. Kotha, Adam J. Peiffer, Robert P. Lesko, Barry Tannen, Noah Tannen, Edward H. Davidson

Research output: Contribution to journalArticlepeer-review


Introduction:Persistent diplopia following orbital fracture is a well-recognized problem. While observation is the standard-of-care, symptoms may be protracted. Orthoptic vision therapy is a form of ocular physical therapy that achieves functional rehabilitation through targeted exercises. This study presents a protocol for post-traumatic orthoptics and describes preliminary results.Materials and Methods:Protocols for home-therapy/office-assessment were developed using commercial software and exercises targeting motility and fusion. Office-assessment also included validated questionnaire chronicling symptomatology. Healthy-volunteers (n = 10) trailed the protocol three times (n = 30) and normative data was compiled. Comparative measurements were made in chronic (>1year; n = 8) and acute (<2 weeks; n = 4) fracture cohorts. Time-of-therapy was recorded, monetary cost-analysis performed, and side-effects assessed.Results:Severe/moderate motility limitation was found in 3 of 4 acute fracture patients but not in chronic or healthy cohorts. The acute cohort had worse fusion when comparing convergence (mean break/recovery of 8.0/6.5 prism diopters (pd) versus 31.87/21.23pd; P = 0.001/0.015) and divergence (3.00/1.50pd versus 18.37/12.83pd; P = 0.000/0.001) to the healthy cohort. Those with chronic fracture had lower convergence (15.71/5.00pd; P = 0.01/0.001) and divergence (12.29/4.71pd; P = 0.04/0.002) when compared with healthy subjects, but better function than acute patients. Acute fracture patients reported greater symptomatology than chronic (mean score 18.8 versus 4.6; P = 0.003) or healthy (5.0; P = 0.02) groups, but there was no difference between chronic and healthy groups (P = 0.87). Assessment took <10 minutes. Per patient software cost was <$70. Mild eyestrain related to therapy was self-resolving in all cases.Conclusions:Orthoptic therapy may improve fusion and motility following orbital fracture. This protocol serves as basis for prospective work.

Original languageEnglish (US)
Pages (from-to)1025-1028
Number of pages4
JournalJournal of Craniofacial Surgery
Issue number3
StatePublished - May 1 2021
Externally publishedYes


  • Diplopia
  • Facial trauma
  • Orbital fracture
  • Orthoptic vision therapy

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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