Surasmiati Ni Made Ayu, Budi Ni Made Wasiastiti, Djelantik Aaa Sukartini, Utari Ni Made Laksmi, Yuliawati Putu, Suryathi Ni Made Ari
Ophtalmology Department, Udayana University, Faculty of Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia.
Open Access Maced J Med Sci. 2019 Jun 14;7(11):1825-1827. doi: 10.3889/oamjms.2019.487. eCollection 2019 Jun 15.
Incomitant exotropia is one of ocular complication that has been reported after intranasal surgery. This case report aims to describe the causes of exotropia in a patient with a history of nasal polyp surgery.
A 50-years-old male, came with the main complaint of double vision 1 month after nasal polyp surgery. He also complained his right eye turned outward. The visual acuity on the right eye was 6/7.5 with his head turn to the left. On the examination, the Hirschberg test was XT 45°, and the Krimsky test > 95 ∆BI. Duction and version test on the right eye were -4 adduction. There was no shifting on the cover-uncover test. Ishihara test was within normal limit, and there was suppression on the right eye in WFDT. On force generation test, we found limited adduction on the right eye and no restriction in force duction test. Head MRI showed atrophy of medial recti on the right eye, 2.2 mm in size. The patient underwent vertical muscle transposition procedure surgery, and it was found atrophy of medial recti without any rupture. Two months after surgery, the double vision was decreased, the result of the Hirschberg test was XT 30° and Krimsky test 65°∆BI.
Nasal polyp surgery-related incomitant exotropia mostly caused by extraocular muscles rupture. In this case, we found no rupture. Therefore, we suspected the abnormalities of muscles vascularisation, supported by the atrophy of medial recti.
非共同性外斜视是鼻内手术后报道的眼部并发症之一。本病例报告旨在描述一名有鼻息肉手术史患者发生外斜视的原因。
一名50岁男性，以鼻息肉手术后1个月出现复视为主要诉求前来就诊。他还抱怨右眼向外偏斜。当他向左转头时，右眼视力为6/7.5。检查时，角膜映光法检查显示外斜45°，三棱镜检查＞95△BI。右眼的牵拉试验和转位试验显示内收-4。遮盖-去遮盖试验无移动。色盲检查在正常范围内，在双眼视野分离试验中右眼有抑制。在力量产生试验中，我们发现右眼内收受限，力量牵拉试验无受限。头部MRI显示右眼内直肌萎缩，大小为2.2mm。患者接受了垂直肌转位手术，术中发现内直肌萎缩但无任何破裂。术后两个月，复视减轻，角膜映光法检查结果为外斜30°，三棱镜检查为65°△BI。
鼻息肉手术相关的非共同性外斜视大多由眼外肌破裂引起。在本病例中，我们未发现破裂。因此，我们怀疑是肌肉血管化异常，右眼内直肌萎缩可作为支持依据。
