Post-ROCM restrictive strabismus: A challenge for strabismus surgeon

Abstract

Restrictive strabismus is characterized by extraocular motility restriction, which is confirmed by performing forced duction test. It can be congenital because of various syndromes or acquired after thyroid eye disease, after long-standing strabismus, after sinus surgery, or after trauma. Recently, we have faced a devastating epidemic of rhino-orbito-cerebral mucormycosis (ROCM) during the second wave of COVID-19 pandemic, which was treated by both surgical (sinus surgery) and medical (antifungal agents) modalities. Diabetes mellitus and the inadvertent use of systemic steroid were the leading risk factors for ROCM outbreak. India being the diabetic capital of the world favored this condition. We are reporting a challenging case of ROCM with diabetes mellitus, who presented to us with troublesome diplopia with extraocular motility restriction. He had a history of right-sided ROCM treated by sinus surgery and systemic antifungal agents 1 year back, followed by a good residual vision and restrictive strabismus leading to the symptoms. A previous history of sinus surgery and post-ROCM scarring and narrow surgical field posed a great challenge for strabismus surgery. In spite of all odds, a good postoperative alignment was achieved by a single-stage strabismus surgery, and the patient was asymptomatic after 3 months of follow-up.