Superior Rectus Muscle Entrapment Following Orbital Roof Fracture: A Rare Case Report

2026-04-01

PRE

Aishwarya M Angadi

Pradipta Pramod Potdar *

Jakhalu, Kalibo

Shikha Rai

DOI：10.7860/JCDR/2026/79374.22829

Original

Original request for help

Save

Abstract

En 中文

Superior Rectus (SR) palsy is a rare and often overlooked consequence of orbital trauma, particularly when associated with orbital roof fractures. The SR muscle plays a critical role in ocular elevation, and its dysfunction can lead to diplopia, ptosis, and significant visual impairment. While inferior and medial rectus entrapments are more commonly reported, SR involvement is exceedingly uncommon due to its protected anatomical location. Here, the authors report a rare case of a 20-year-old male who presented with persistent binocular diplopia and restricted upward gaze in the left eye, two months following a road traffic accident. Clinical examination revealed left upper eyelid ptosis and limited elevation, while imaging studies confirmed an orbital roof fracture with suspected entrapment of the SR muscle. Due to persistent symptoms and functional impairment, surgical intervention was undertaken via a sub-brow orbitotomy. Intraoperatively, a displaced bony fragment was identified and removed, relieving the muscle entrapment. Postoperative follow-up showed significant improvement in ocular alignment and resolution of diplopia. The present case highlights the importance of maintaining a high index of suspicion for extraocular muscle entrapment in orbital roof fractures and underscores the role of early imaging and timely surgical intervention in preventing long-term ocular morbidity.

Keywords:

Diplopia

Extraocular muscle entrapment

Oculomotor muscles

Orbital trauma

Surgical decompression

Superior Rectus Muscle Entrapment Following Orbital Roof Fracture: A Rare Case Report

Abstract

Journal

Organization