A modified technique for attaching the lateral rectus muscle to the orbital periosteum through a skin incision over the lateral orbital rim.

BACKGROUND: The traditional approach for periosteal fixation of the lateral rectus muscle involves securing the muscle using nonabsorbable sutures by exposing the orbital periosteum 5 mm to the inside of the orbital margin. We present a simplified approach that exposes the orbital periosteum through a skin incision, providing more room and avoiding extraconal fat manipulation. METHODS: We used our technique to expose the lateral orbital periosteum and suture the lateral rectus muscle to the periosteum using nonabsorbable sutures in 2 patients with exotropic Duane retraction syndrome and 1 patient with congenital oculomotor nerve palsy. RESULTS: All 3 patients had satisfactory postoperative alignment, with abduction limitation of 3-. Adduction improved in all patients. The patient with oculomotor nerve palsy had a small overcorrection in primary position that remained stable during follow-up of 18 months. There were no intraoperative complications. CONCLUSIONS: This modified approach to extraocular muscle periosteal fixation may be simpler than the standard approach. Further evaluation in a larger series of patients is warranted.

Surgically Induced Necrotizing Scleritis Following Strabismus Surgery Treated Successfully with Topical N-acetylcysteine in a Child with Congenital Fibrosis of Extraocular Muscles and Varadi Papp Syndrome.

INTRODUCTION: Surgically induced necrotizing scleritis (SINS) is a rare but serious disorder that can develop many years after strabismus surgery. It is generally treated with high-dose steroids or immunosuppression. CASE REPORT: We describe a patient with Varadi Papp syndrome and congenital fibrosis of the extraocular muscles, who developed surgically induced necrotizing scleritis a month after strabismus surgery and was successfully managed by oral vitamin C and topical N-acetylcysteine 10%. DISCUSSION: While SINS is conventionally treated with steroids/immunosuppression, a conservative approach may be tried in milder cases. The role of topical N-acetylcysteine in managing this complication needs to be explored.

Recurrent Brown's Syndrome after Superior Oblique Tendon Recession Treated by Silicone Spacer.

INTRODUCTION: Undercorrections have been reported after a number of surgical procedures for Brown's syndrome. The reason for late undercorrections is not clear but may be related to the heterogeneous etiology of Brown's syndrome. PURPOSE: We report a patient with late undercorrection after superior oblique tendon recession for Brown's syndrome that was partially relieved by a silicone spacer placed nasally. RESULTS: We noted on surgical exploration that the superior oblique tendon had attached to the sclera under the nasal border of the superior rectus. Further weakening of the tendon was achieved by a No. 240 band expander that resulted in improvement of adduction in elevation. CONCLUSION: Undercorrections following surgery for Brown's syndrome can be relieved by further weakening the superior oblique muscle. However, as late undercorrections have been reported, the optimal timing of surgery is not certain.