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Incomitant Exotropia After Nasal Polyp Surgery.

Ni Made Ayu Surasmiati¹, Ni Made Wasiastiti Budi¹, Aaa Sukartini Djelantik¹

¹Ophtalmology Department, Udayana University, Faculty of Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia.

Open Access Macedonian Journal of Medical Sciences

|July 19, 2019

Summary

Incomitant exotropia after nasal polyp surgery may stem from medial recti atrophy, not just muscle rupture. This case highlights vascularization abnormalities as a potential cause.

Keywords:

Exotropia Incomitant Nasal Polyp

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Area of Science:

Ophthalmology
Neurosurgery

Background:

Incomitant exotropia is a known ocular complication following intranasal surgery.
This report details the etiology of exotropia in a patient post-nasal polyp surgery.

Observation:

A 50-year-old male presented with diplopia and right eye outward deviation one month after nasal polyp surgery.
Examination revealed significant exotropia (XT 45° Hirschberg, >95 ∆BI Krimsky) and limited right eye adduction.
Head MRI showed right medial recti atrophy (2.2 mm) without rupture.

Findings:

The patient underwent vertical muscle transposition surgery due to medial recti atrophy.
Post-operatively, diplopia decreased, and exotropia improved (XT 30° Hirschberg, 65°∆BI Krimsky).

Implications:

Unlike typical cases, this exotropia was not caused by extraocular muscle rupture.
Abnormalities in muscle vascularization, evidenced by medial recti atrophy, are suspected causes.
This suggests a need to consider vascular factors in managing post-intranasal surgery incomitant exotropia.