DR. BHAWNA PIPLANI

DR. ASHOK KUMAR KHURANA, DR. CHAWLA URMIL

Abstract

27 year girl came with inward deviation both eyes & upward deviation left eye since early childhood. Previous squint surgery elsewhere 18 years back.

BCVA-6/6 ; (with+6.5 DS)

Ocular motility-left SO underaction grade 2, left grade 4 IOOA, residual infantile esotropia, DVD, LN & SPA. Parks 3 step test s/o left SO palsy. DMR -extorsion 5 degree. W4DT- alternate suppression. Stereopsis- gross. Diagnosis- left congenital SO palsy & residual infantile esotropia

PBCT- 18 PD L/R & 18 PD eso in primary (N=D) ; V pattern

B/L medial conjunctival scar due to previous bilateral MR surgery

Fundus-right trace intorsion & left grade 4 extorsion

FDT left SR- negative. FGT ,both MR-positive. Exaggerated FDT left SO- grade 2 laxity.

MRI orbit & AS-OCT -WNL

On table, Right LR not found at insertion, slipped LR attached to stretched scar found

Right LR advancement & resection & left LR resection with left anterior & nasal transpositioning of IO done

Patient has good ocular alignment on 2 year follow up