Esotropia following bilateral lateral orbital decompressions for Graves' disease

A 48-year-old woman with mild Graves' orbitopathy underwent bilateral lateral orbital decompressions through preauricular hairline incisions by a general plastic surgeon. Immediately postoperatively she developed marked left orbital and eyelid edema and incapacitating diplopia due to a large angle esotropia and severe bilateral abduction deficits. Examination 13 months later revealed normal visual acuities and a 90 prism diopter esotropia. She underwent complex strabismus surgery with resultant orthophoria in primary and down gaze. Four years later, a thin section computed tomographic scan revealed severe attenuation of both lateral rectus muscles with incarceration of the muscle bellies into the lateral osteotomy sites. This case demonstrates a rare, but avoidable, complication of orbital surgery for Graves' disease.