Lateral rectus sag and recurrent esotropia in children

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus Surgery

Background:

• Recurrent esotropia in children can be challenging to manage.
• Anatomic abnormalities may contribute to persistent strabismus after surgery.

Observation:

• Four pediatric patients with recurrent esotropia post-bilateral medial rectus recession were studied.
• Anatomic abnormality identified: inferiorly displaced lateral rectus muscle paths near the globe's equator.
• Patients presented with acquired esotropia, with one developing overelevation in adduction.

Findings:

• Esotropia recurred in all patients after standard surgery.
• Surgical findings revealed lateral rectus paths displaced >0.5 tendon width inferiorly.
• Combined lateral rectus resection and equatorial myopexy achieved stable esotropia correction.

Implications:

• Lateral rectus sag is a distinct cause of pediatric acquired esotropia.
• This condition is often refractory to standard strabismus surgery.
• Equatorial myopexy provides permanent fixation, normalizing the muscle path for successful correction.