Upper eyelid retraction and superior recti stretched scar

Purpose: To describe a case of upper eyelid retraction secondary to previous superior recti recessions in association with stretched scars. Case Report: A 26-year-old female patient presented with upper eyelid retraction and exotropia for four years. She had undergone bilateral medial and superior rectus recessions for the treatment of esotropia and dissociated vertical deviation five years earlier at another institution. The patient was otherwise healthy, and an evaluation for thyroid eye disease was negative. During surgery, stretched scars were found in both superior recti and the left medial rectus. The scarred segments were excised, and the muscles were reattached to the sclera using 6-0 polyglactin sutures. One year postoperatively, the patient was orthotropic and had no upper eyelid retraction. Discussion: Stretched scars, characterized by elongated muscular insertions, are a known cause of secondary strabismus and are thought to be associated with wound healing issues. Although they are a common cause of consecutive exotropia following medial rectus recessions, there are only a few reports of stretched scars in recessed superior rectus muscles in the literature. We report the case of eyelid retraction secondary to previous superior recti recessions in which the development of stretched scars might have played a role in the occurrence of the retraction.