Post-strabismus surgery aqueous misdirection syndrome

A 24-year-old man was referred to the glaucoma clinic of our tertiary eye care centre in view of uncontrolled intraocular pressure (IOP) in the left eye despite maximal medication. The patient had undergone left eye cosmetic squint surgery 1 month before (medial rectus resection 9 mm and lateral rectus recession 12 mm) for congenital third nerve palsy. Post-squint surgery, the patient developed pain and was being managed symptomatically. However, 1 week later, he developed diffuse corneal oedema and severe pain, and was readmitted for management in the same hospital. He presented to our centre with an IOP of 16 mm Hg in the right eye and 58 mm Hg in the left eye. We made a diagnosis of left eye post-strabismus surgery aqueous misdirection syndrome, and performed left eye core vitrectomy with 360° goniosynechialysis and ultimately a trabeculectomy to reduce IOP.