Dynamic Magnetic Resonance Imaging- a sensitive tool in managing consecutive exotropia.

Area of Science:

• Ophthalmology
• Strabismus Management
• Diagnostic Imaging

Background:

• Accurate diagnosis and evaluation are essential for effective strabismus management.
• Consecutive exotropia can present as a complex challenge, particularly in long-standing cases.

Purpose of the Study:

• To report a case of prolonged, large-angle complicated consecutive exotropia.
• To demonstrate how dynamic Magnetic Resonance Imaging (MRI) aided diagnosis and management planning.

Main Methods:

• A 19-year-old male with a 16-year history of outward eye deviation and prior squint surgeries was evaluated.
• Diagnostic tools included visual acuity, extraocular movement assessment, Prism Alternate Cover Test (PACT), Forced Duction Test (FDT), and dynamic MRI.
• Surgical intervention involved Medial Rectus (MR) advancement and Lateral Rectus (LR) recession.

Main Results:

• Dynamic MRI revealed posterior insertion of the left medial rectus and thinning of left lateral and medial rectus tendons.
• Post-surgery, the patient showed improved resistance on FDT.
• Excellent outcome achieved with 5 PD primary position exotropia and improved left eye adduction after 3 months.

Conclusions:

• Precise workup and targeted investigations are key to successful management of large-angle consecutive exotropia.
• Dynamic MRI can significantly aid in diagnosing complex strabismus cases.
• Appropriate surgical intervention, guided by detailed diagnostics, leads to excellent patient outcomes.