Pulled-in-Two Syndrome

A 61-year-old female with longstanding left sixth nerve palsy secondary to meningioma that was resected. Her visual acuity OD was 20/20, OS 20/40. Her traction testing OS revealed severe restriction to abduction. She had visual confusion with superimposition of the images that was bothersome to her. She wore a patch to avoid seeing double. Surgical intervention was planned after the deviation was found to be constant over 6 months. She was to undergo chemodenervation of left medial rectus with supramaximal recession and lateral rectus anchoring to the L- plate. During the procedure, she had the rare complication of medial rectus pulled-in-two syndrome that was effectively managed by the operating surgeons. This presentation discusses the mechanism, risks factors, management and outcome in a case with intraoperative Pulled-In-Two syndrome of the medial rectus muscle. 

Presentation Date: 10/17/2019

Issue Date: 08/01/2020