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