Recovery after orbitial fracture repair

At the End of last August (so just under 6 months ago), I have surgery to repair an orbital blow out fracture. Prior to the surgery, I had double vision when looking up or down (not in primary position, but extended gaze).
Now, at nearly 6 months after the operation, I still have a little double vision when looking up (extended gaze). Is this likely to improve further over time, or is this pretty much how it will always be?
Any comments appreciated.

[John C Hagan III, MD, FACS, FAAO]

At 6 months not likely to get better. Doesn't sound bad enough to do surgery. See a pediatric ophthalmologist strabismus specialisst.

JCH MD

[goodladmark]

Hi John, many thanks for your reply to my recent post.
I had a check up last week, I first saw the Orthoptics Doctor who did a vision field test, this test showed my injured eye had difficulty getting to the upper limit of its motion. I asked what the cause was, they suggested one possibility could be a trapped muscle (aquired during the blow out fracture repair surgery)- I would have thought this unlikely as the idea of the surgery is to release any trapped muscle?

I saw a second Doctor in the clinic after, who commented that a possible way to improve things would be eye muscle surgery (squint), but this could to complications with my primary vision, so was not advisable.
I am a little confused as to what causes the double vision post surgery- trapped muscle, or weak / damaged eye muscle? Or even the eyes just not working together beyond a certain point?

Thanks and best regards

Mark

[John C Hagan III, MD, FACS, FAAO]

Double vision can be due to entrapped muscles or damage to the nerve supply.  Most studies show that permament double vision is less without surgery than with unless there is a huge entrapment.

Very little time is spent looking up and even then you can look up using your neck.

There is no guarentee that surgery would make the condition better and it coud make it worse so if no surgery is recommended should consider taking their advice.

JCH MD