Dr.R. R. MALARVIZHI, Dr. ANURADHA ALAGUSUNDARAM, Dr. Sudarvizhi A
Abstract
A 18 yr old girl came with h/o outward deviation of LE since 14 yrs. H/O surgery for esotropia at the age of 3 yrs. Old records showed h/o left MR recession 5.5 mm and left LR resection 9 mm done 14 years back. O/E, BCVA RE 6/6, LE 6/18. Hirschberg test showed exotropia of 30° in the left eye. PBCT demonstrated exotropia of 60 PD fixing each eye in primary gaze. EOM full. Patient was planned for LMR advancement under local anaesthesia. Intraoperatively there was difficulty in identifying MR muscle due to excessive scarring from previous surgery. Thin capsule with few muscle fibres were found 5.5 mm from the insertion site. The muscle fibres were advanced and sutured to the original insertion site.LR recession of 9mm was done. Postoperatively the outcome was good with residual exotropia of 20PD. Management of consecutive exotropia is challenging because of scarring from previous surgeries, requirement of multiple surgeries and lack of well established surgical dose corrections.
Leave a Comment