Intrastromal corneal tattooing as treatment in a case of intractable strabismic diplopia (double binocular vision)

We present the case of a 29 man complaining of intractable diplopia during the last 5 years. He had undergone several surgical procedures for the treatment of his infantile strabismus since age 6 years. After surgery, the patient had been treated on 4 occasions with Botox. He also performed antisuppression exercises to encourage binocular vision. On our examination, the patient showed a 20/20 visual acuity in both eyes and a strabismic dysfunction with slight alphabet pattern, which induced a disturbing constant diplopia. Several treatment options were considered as occlusion therapy or cosmetic contact lenses, but they were not used because they were not acceptable esthetically or not tolerated. Finally, an optical penalization was induced by means of a black corneal tattooing placed at the centre of the cornea. The patient was followed for a period of 18 months, showing a complete elimination of diploia with esthetical acceptance and no inflammatory signs.