Iatrogenic Medial Rectus Transection

Patient presented with acute onset binocular horizontal diplopia and an incomitant left exotropia with severe, but not complete adduction deficit. On orbital imaging, the medial rectus appeared to be completely transected, however the patient maintained some adduction ability and thus likely had functioning medial rectus fibers. Management options included observation vs surgical exploration with possible MR/LR recess/resect vs transposition, vs tethering procedures. Observation was elected and patient placed in prism glasses. 3 months later, patient motility examination was slightly improved. 1 year following the injury, motility had improved, and patient was happy with single vision in primary gaze.

Presentation Date: 02/04/2021

Issue Date: 08/05/2022