This single centre retrospective case series included 15 patients with restrictive diplopia after ptergium excision. The mean time from surgery to diplopia was six months and all patients had a moderate limitation of abduction in the operated eye causing an esotropia. Surgery to remove scar tissue formation was carried out using a team approach including a strabismus surgeon and an oculoplastic or corneal surgeon. The medial rectus was not recessed in any surgery. One patient underwent a lateral rectus resection in the affected eye. Eleven patients received MMC or 5-FU intraoperatively and eight patients received postoperative injections of 5-FU. One patient declined surgical intervention and underwent botulinum toxin injection instead into the medial rectus, which also resolved the diplopia. Of the patients that had surgical intervention no patient complained of diplopia in primary position postoperatively. Eleven patients (73%) complained of persistent subjective diplopia only at extreme abductive gaze. The authors conclude that although diplopia is a potential complication after pterygium surgery is it easily correctable by surgically removing the scar tissue without the need for medial rectus recession. This is only a small study but highlights the importance of counselling patients prior to ptergium surgery especially repeat surgery on the risk of diplopia.
Management of restrictive diplopia after ptergium surgery
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