To the Editor.
—Extraocular muscle injury is an unusual sequela of pterygium surgery, although the area of dissection is just adjacent to these structures.1-3 We have seen three patients who experienced the acute onset of horizontal diplopia following excision of a nasal pterygium. In all patients, noncomitant exotropia and marked adduction deficiency were observed.
Report of Cases.
—A 53-year-old woman noted horizontal diplopia immediately following excision of an extensive nasal pterygium of the left eye. When seen on the fourth postoperative day, adduction was possible only to the midline, with observably slow nasal saccades and exotropia (Fig 1). The nasal sclera of the eye operated on was bare from the limbus for about 9 mm. On the following day, surgical exploration was performed. The traction test indicated no restrictions. The left medial rectus was found to be disinserted and was reattached just behind its original insertion
Raab EL, Metz HS, Ellis FD. Medial Rectus Injury After Pterygium Excision. Arch Ophthalmol. 1989;107(10):1428. doi:10.1001/archopht.1989.01070020502018