A Case of Surgical Repair For Convergent Strabismus Fixus with Bilateral Abducens Nerve Palsy

ABSTRACT

PURPOSE: We report a case in which a convergent strabismus fixus due to head trauma-induced bilateral abducens nerve palsy was successfully corrected. METHODS: A 45-year-old male patient who had bilateral,convergent strabismus fixus and limited eye movement because of bilateral abducens nerve palsy. A year previously, the patient had experienced a skull fracture and right facial nerve palsy caused by a traffic accident. At that time, the forced duction test revealed severe restriction of both eyes. The forced duction test still showed resistance after the right medial rectus muscle was disinserted. We made a conjunctival incision on the lateral canthal area and resected the right lateral rectus muscle. Then we performed lateral canthotomy, and fixed the lateral rectus muscle to the periosteum of the lateral orbital rim. When the left medial rectus muscle was disinserted, there was no resistance on the forced duction test. We then addressed the medial rectus muscle recession, superior and inferior rectus muscle transposition to the lateral rectus. RESULTS: Two years after the procedure, bilateral convergent strabismus fixus did not recur, even though right eyeball movement was impossible. Patient appeared an orthophoria at the primary position, and the cosmetic rersult was satisfactory.