Unveiling restrictive strabismus in a Complex presentation With residual esotropia - A case report

Area of Science:

• Ophthalmology
• Neurology
• Pediatric Surgery

Background:

• Strabismus, or ocular misalignment, can be congenital or acquired, presenting diverse clinical features.
• Restrictive strabismus, characterized by limited eye movement due to mechanical restriction, poses diagnostic challenges.
• Orbital abnormalities can mimic or cause restrictive strabismus, necessitating comprehensive evaluation.

Purpose of the Study:

• To discuss conditions mimicking restrictive strabismus and their management.
• To highlight the diagnostic challenges and surgical considerations in complex strabismus cases.
• To emphasize the importance of identifying underlying causes of persistent esotropia.

Main Methods:

• Case report of a 14-year-old girl with congenital esotropia and a history of meningocele surgery.
• Clinical examination including visual acuity, ocular motility assessment, and force duction testing.
• Surgical intervention involving release of cicatricial tissue, medial rectus recession, and subsequent lateral rectus resection.
• Neuroimaging to identify the underlying etiology.

Main Results:

• Initial diagnosis of congenital esotropia with restrictive features.
• Post-operative persistence of esotropia after initial surgery.
• Neuroimaging revealed a fronto-orbital meningoencephalocele causing fibrosis around the medial rectus tendon.
• Second surgery achieved orthophoria.

Conclusions:

• Orbital structural abnormalities are potential causes of restrictive strabismus, particularly when clinical features are atypical.
• Accurate diagnosis and management of restrictive strabismus require meticulous history taking and thorough clinical examination.
• This case underscores the need to consider rare etiologies in persistent or atypical strabismus presentations.