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Abstract: Mr. Zhang, 37 years old, complained of “outward deviation of the right eye” for more than 30 years and came to the hospital for treatment. After completing the preoperative examination, he was operated under local anesthesia to correct the exotropia. After the operation, the eye position was restored to the right position, and the patient was satisfied with the recovery of appearance.
Basic information】Male, 37 years old
Disease Type】Exotropia
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of consultation】May, 2020
Treatment plan】Extraocular muscle surgery (posterior migration of the external rectus muscle in the left eye, posterior migration of the external rectus muscle in the right eye, and shortening of the internal rectus muscle in the right eye during surgery)
Treatment period】5 days of hospitalization, 3 weeks and 3 months of re-examination
Treatment effect】Eye position restored to proper position
I. Initial consultation
Mr. Zhang, 37 years old, had been visiting our department for more than 30 years because of the outward deviation of his right eye. Physical examination of both eyes: -45°, alternating masking: external→medium, no significant abnormalities in eye movements. Visual acuity: OD0.8, OS1.0. no significant abnormalities in the anterior segment and fundus of both eyes. IOP: R15mmHg, L14mmHg. dilated pupil optometry: OD +1.00DS+0.50DC*15=0.8+, OS +1.25DS+0.50DC*10=1.0. synoptic machine I: objective-55°, II: none, III: none, Worth four-point light: near 3 lights, far 3 lights. The diagnosis of exotropia was made based on the patient’s physical signs as well as the examination.
II. Treatment history
Considering the patient’s large strabismus angle, long deviation time, and severe bilateral visual impairment, after full communication with the patient, we planned to correct ectropion through extraocular muscle surgery, and this surgery was mainly aimed at improving the appearance, focusing on protecting visual acuity and eye movement flexibility. The surgery was completed under local anesthesia after perfecting the trigeminal plus masking examination before the surgery, and the surgical plan was formulated and implemented. The patient was satisfied with the posterior position of the eye. After surgery, topical levofloxacin hydrochloride eye drops, pralofene eye drops, and tobramycin dexamethasone eye ointment were given. The patient was discharged after 5 days of hospitalization and instructed to avoid rubbing the eye, adhere to regular medication, and review 3 weeks and 3 months postoperatively.
III. Treatment effect
At the outpatient review 3 months after the operation, the patient was satisfied with the eye position and had no special discomfort. Examination of visual acuity OD0.8, OS1.0, complete healing of the conjunctival incision in both eyes, restoration of ortho-position, alternating masking immobility, and eye movements in all directions in place. Synoptic machine Ⅰ: +1°, Ⅱ: none, Ⅲ: none, Worth four-point light: near 2 or 3 lights, far 2 or 3 lights, indicating orthotropic eye position and obvious improvement in appearance, the patient was satisfied. However, binocular visual function was still not restored, so the patient was encouraged to perform binocular vision training.
IV. Notes
We are glad that the patient has resolved the disease that has plagued him for more than 30 years after undergoing surgical treatment. Since patients will experience temporary discomfort such as bulbar conjunctival congestion, foreign body sensation, and double vision after surgery, the above symptoms usually improve gradually within 3-9 weeks after surgery, so there is no need to be overly anxious. On the first day after surgery, patients can open their eyes and see things. Encourage patients to get out of bed as soon as possible, avoid rubbing the eyes and extensive eye rotation, and avoid contacting the conjunctival incision with foreign bodies or non-sterile fluids. Pay attention to the use of relevant eye drops for care as prescribed by the doctor to avoid postoperative infection. The first postoperative review was conducted 3 weeks after surgery, and refractive correction and binocular vision training guidance were given according to the condition.
V. Personal insight
For adult patients with exotropia, improvement of appearance may be the primary medical appeal, so it is important to adequately correct the exotropia during surgery and design the amount to give enough to avoid early postoperative recurrence as much as possible. Even in adult patients, postoperative binocular vision training is an important component of comprehensive strabismus treatment, and only by establishing binocular vision early can postoperative eye position be better stabilized. In addition, medical practitioners should proactively increase publicity efforts to make more people aware of the fact that exotropia can be treated surgically through publicity, so as to avoid such a delay of more than 30 years in which strabismus has been thought to be untreatable.