A surgical option for antipodean strabismus: four horizontal muscle resection

Area of Science:

• Ophthalmology
• Neuroscience
• Endocrinology

Background:

• Thyroid eye disease (TED) can cause mechanical restriction of ocular motility.
• Antipodean strabismus, characterized by divergent deviations, can be exacerbated by convergence insufficiency.
• Complex strabismus requires tailored surgical approaches for effective management.

Observation:

• A patient presented with symptomatic antipodean strabismus.
• The strabismus was attributed to a combination of TED-related mechanical restriction, intermittent divergence, and convergence weakness.
• The patient experienced significant visual impairment and discomfort due to the eye misalignment.

Findings:

• Surgical resection of all four horizontal recti muscles was performed simultaneously.
• This comprehensive surgical intervention effectively addressed the multifaceted etiology of the strabismus.
• The patient experienced significant alleviation of symptoms post-operatively.

Implications:

• Simultaneous horizontal recti muscle resection is a viable treatment for complex strabismus.
• This approach can successfully manage strabismus resulting from combined mechanical restrictions and muscle palsies.
• Effective management of thyroid eye disease-related strabismus improves patient quality of life.