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Case of the week 61  ( June 2012 )

Exotropia and hypertropia in a ‘blind’ eye

5 years old child has had an ocular trauma of the left eye 3 years ago leaving a huge non-operable macular scar , he never regained good vision at this eye . VA is 6/6 OD , light perception OS
the left eye is XT and Hypertropic with comitanace in all gazes


Aligning a non-seeing eye is a legitimate undertaking using the dictum ‘every humans has the right to look like a human’. Surgery should be restricted whenever possible to the poorer seeing eye.  A logical choice for surgery would be:
1) Recession of the left lateral rectus 8.0 mm with 1/2 muscle width down shift
2) Resection of the left medial rectus 8.0 mm with 1/2 muscle width downshift

This regimen will make the child slightly esotropic , In surgeries for aligning a blind exotropic eye , I usually leave my patient with slight consecutive  ET , this works good with me guarding against recurrence of the XT

The downshift of both of the horizontal recti in the left eye will have some effect on lowering the hyper deviated left eye. In this case it is wise to avoid the left superior rectus because of concerns about thin sclera as a result of prior trauma in the area. The inferior oblique is not the most effective muscle to weaken for treating this kind of hyperdeviation.

Pre Post operative

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