A Case of Decompensated Esotropia after LASEK

ABSTRACT

PURPOSE: To report a 38-year-old woman who showed esotropia and diplopia after LASEK surgery. METHODS: A 38-year-old mildly myopic woman, who didn't ordinarily need glasses or contact lenses, visited our clinic complaining of sudden onset of esotropia and diplopia following LASEK. Although she had had rarely intermittent esotropia in the past, her orthophoria had been maintained usually. The refractive error, -2.00 Dsph=-0.75 Dcyl x 172 A in the right eye and -2.50 Dsph=-0.75 Dcyl x 27 A in the left eye before LASEK. was improved to -0.50 Dsph -0.25 Dcyl x 48 A in the right eye and -0.25 Dsph in the left eye after LASEK. However, she showed acute esotropia of 40 prism diopters (PD) at near and 30 PD at distance and diplopia. The Worth 4 dot test and Bagolini striated lens test indicated left suppression. In the Titmus stereo test, she exhibited loss of stereoacuity. RESULTS: Her esotropia persisted for two months after first visiting our clinic, so we performed surgery of unilateral lateral rectus muscle resection and medial rectus muscle recession. After strabismus surgery, she showed orthophoria and the diplopia disappeared, while fusion and stereoacuity were regained. CONCLUSIONS: The clinical course of this patient suggested that recovery of accommodative need convert esophoria to esotropia. Therefore we recommend meticulous preoperative evaluation of strabismus in all candidates for refractive surgery.