PMC5369298_01
A 19-year-old boy with large-angle exotropia and limited ocular movements. Nine gaze pictures revealed absence of adduction in each eye
IJO-65-62-g001.jpg
PMC5369298_01_IJO-65-62-g001.jpg
F1
He had a large-angle exotropia (>100 PD) as measured by modified Krimsky test in all nine diagnostic positions of gaze [Fig. 1].
Computed tomography scan of the orbits (a) axial sections revealed absence of medial rectus muscle in both eyes (arrow) and (b) coronal sections revealed absence of medial rectus muscle in both eyes (arrow)
IJO-65-62-g002.jpg
PMC5369298_01_IJO-65-62-g002.jpg
F2
Computed tomography scan showed the absence of medial rectus muscle in either eye in both the axial and coronal cuts [Fig. 2a and b].
(a) During surgery, absence of the medial rectus muscle was noted (b) superior oblique tendon transfer was performed with satisfactory correction of the exotropia
IJO-65-62-g003.jpg
PMC5369298_01_IJO-65-62-g003.jpg
F3
Exploration during surgery revealed complete absence of the medial rectus muscle [Fig. 3a]. Good correction of the exotropia was obtained with the measurement in the primary position being 15 PD of exotropia at 3-year follow-up [Fig. 3b].
PMC5369298_02
(a) A 7-year-old girl presented with exotropia and limited ocular movements (b) during surgery, the lateral rectus muscle and the (c) medial rectus muscle were dystrophic
IJO-65-62-g004.jpg
PMC5369298_02_IJO-65-62-g004.jpg
F4
Ocular examination revealed the presence of 70 PD of exotropia (on modified Krimsky test), with preference for right eye fixation though she could hold fixation well with each eye [Fig. 4a]. Tenon's capsule [Fig. 4b and c]. To correct the exotropia, a superior oblique tendon transfer (with resection) to the superior part of the normal insertion area of the medial rectus was performed.