Acute esotropia: a tale of an isolated medial wall trapdoor fracture with medial rectus entrapment

Isolated medial wall fractures are far less common than floor fractures. Uncommon but rather serious, are patients who present with adduction or abduction deficit following medial wall fractures. We present a case with medial wall fracture and medial rectus entrapment. The patient presented with acute esotropia and diplopia with limitation of abduction preceded by blunt trauma. Computed tomography revealed the fracture along with medial rectus entrapment. Surgical repair using Medpor and release of entrapped tissue was performed within 48 h, following which patient had exotropia with adduction deficit. Six weeks later symptoms resolved with minute adduction deficit. While isolated medial wall fractures are uncommon and most of the time asymptomatic, they can cause significant morbidity if muscle incarceration is involved. This uncommon presentation should be recognized and promptly managed to avoid functional complications.