A
48-year-old male tailor by profession came to Ophthalmic OPD of BYL
Nair Ch. Hospital, Mumbai with bilateral nasal pterygium surgery done
2 years ago in a private hospital. The patient complained of Right eye
excessive convergence with diminished vision post operatively. The patient
was operated on Jan. 2000 for bilateral nasal pterygium under local
anaesthesia. After 2 weeks patient developed an excessive convergence
in right eye with diminished vision without diplopia. Previous photograph
of the patient showed that patient was orthophoric. Now patient presents
with recurrent pterygium in both eyes and excessive convergence in right
eye.
On examination, there was Right eye recurrent nasal pterygium with non-accommodative
esotropia 36o, vision being 3 meters finger counting on Snellen’s
chart, no evidence of nerve involvement and no restriction of extra-ocular
movement. There was nasal bare sclera in the Left eye with residual
pterygium tissue over cornea, vision being 6/6. The Left eye was dominant.
Real time ultra-sonography of right eye done using 10 MHz ophthalmic
probe and a synchronized vector A scan showed the posterior segment
was normal. There was no evidence of vitreous haemorrhage or retinal
detachment. Optic nerve was normal. The right medial rectus measures
3.2 mm and is inserted to the equator anterior to its normal insertion
about 4 mm posterior to the ora serrata. This indicates accidental trauma
to medial rectus muscle fibres leading to dis-insertion and reattachment
anterior to its normal insertion. This may have led to the development
of non-accommodative esotropia, explaining the diminished vision and
dominant left eye.
Right eye medial rectus recession 6 mm from insertion (10 mm from limbus)
was done. Adhesions were released from the adnexal tissue. Nasal pterygium
excision with bare sclera teachnique was done under local anaesthesia.
Postoperative evaluation showed an esotropia of 7°. There was no
complaint of diplopia. Residual esotropia (7°) remained after 3
weeks. Patient has binocular vision with visual acuity 6/6 in both eyes
on Snellen’s chart. |
