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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 835-836

Isolated congenital absence of lateral rectus muscle - Diagnosis and management


Department of Pediatric Ophthalmology and Strabismus, M M Joshi Eye Institute, Hubli, Karnataka, India

Date of Submission29-Apr-2021
Date of Acceptance08-Jun-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Deepti Joshi
M M Joshi Eye Institute, Gokul Road, Hosur, Hubli, Karnataka - 580 021
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1029_21

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  Abstract 


Keywords: Absent lateral rectus, isolated, orbital imaging, staged surgery


How to cite this article:
Joshi D, Krishnaprasad R, Agrawal A, Saxena H, Bheema D. Isolated congenital absence of lateral rectus muscle - Diagnosis and management. Indian J Ophthalmol Case Rep 2021;1:835-6

How to cite this URL:
Joshi D, Krishnaprasad R, Agrawal A, Saxena H, Bheema D. Isolated congenital absence of lateral rectus muscle - Diagnosis and management. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 18];1:835-6. Available from: https://www.ijoreports.in/text.asp?2021/1/4/835/327620



Congenital absence of extraocular muscles is a rare cause of restrictive or paralytic strabismus.[1],[2],[3],[4] We present a case of presumed congenital unilateral absence of LR muscle in an otherwise healthy female.

A healthy 52-year-old female with an inconspicuous history presented for cosmetic correction of the deviation of her left eye present since birth.

Best-corrected visual acuity in the right and left eye was 6/6 and 1/60, respectively. On the Krimsky test, she had 70PD left esotropia with gross limitation of abduction [Figure 1]a. Worth's Four Dot test showed left suppression and no stereopsis. Slit-lamp examination and fundus evaluation of both eyes were normal. Magnetic resonance imaging revealed a gross deviation of the left eyeball and an inability to visualize the left LR muscle [Figure 2]. A differential diagnosis of the left esotropia secondary to the absent/dystrophic LR was made. A staged procedure of the left medial rectus (MR) recession followed by vertical rectus transposition (VRT) of the superior and inferior rectus to the presumed position of LR was planned. A forced duction test done on the table revealed a tight MR. Prior to peritomy, blanching of conjunctiva did not reveal any silhouette of LR [Figure 3]a. Post peritomy, exploration around the insertion of LR was made, but the muscle could not be identified [Figure 3]b. MR was recessed using a hang back suture, 10 mm behind the insertion. Five months later, VRT was performed. Following superior peritomy, the superior rectus muscle was cleared backward as far as possible. Two 6-0 vicryl sutures were passed at either side of the insertion and the muscle was severed. The muscle was bodily shifted to the direction of the lateral rectus muscle and was sutured to the sclera at the presumed site of the lateral rectus. A similar procedure was performed on the inferior rectus muscle. The patient had 15PD residual esotropia in the primary position and abduction limitation on the first postoperative day which was maintained till a 6-month follow-up [Figure 1]b.
Figure 1: (a) Gaze photography—preoperatively. (b) Gaze photography—postoperatively

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Figure 2: Magnetic resonance imaging depicting absent lateral rectus muscle

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Figure 3: (a) Blanching of the conjunctiva prior to peritomy showing absent lateral rectus silhouette (b) Intraoperative picture confirming absent lateral rectus muscle

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  Discussion Top


Absent rectus muscle should be considered as a possible cause of squint in congenital cases of incomitant strabismus even in the absence of craniofacial anomalies. This case reinforces the importance of orbital imaging as a diagnostic tool especially when clinical examination of strabismus does not follow routine patterns.[5] Considering anterior segment ischemia, surgery can be planned in stages.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Taylor RH, Kraft SP. Aplasia of the inferior rectus muscle. A case report and review of the literature. Ophthalmology 1997;104:415-8.  Back to cited text no. 1
    
2.
Chan TK, Demer JL. Clinical features of congenital absence of the superior oblique muscle as demonstrated by orbital imaging. J AAPOS 1999;3:143-50.  Back to cited text no. 2
    
3.
Mather RT, Saunders RA. Congenital absence of the superior rectus muscle: A case report. J Pediatr Ophthalmol Strabismus 1987;24:291-5.  Back to cited text no. 3
    
4.
Zoller CC, Graf M, Kaufmann H. Unilateral aplasia of lateral rectus muscle. Klin Monbl Augenheilkd 2001;21855-60.  Back to cited text no. 4
    
5.
Sa HS, Kyung SE, Oh SY. Extraocular muscle imaging in complex strabismus Ophthalmic Surg Lasers Imaging 2005;36:487-93.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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