New diplopic restrictive strabismus as a sequela after conjunctival surgery for conjunctival lesions: a series of 3 cases, management and outcome.

Objective: To present three clinical cases of diplopia secondary to conjunctival surgery (for tumor of caruncle and recurrent pterygium surgery).

Patients and methods: Clinical data of three patients with binocular diplopia and incomitant esotropia associated with compensatory torticollis and duction limitation are shown and discussed. In all cases, a complete ophthalmological examination was performed including ocular motility study, duction test and preoperative evaluation under general anesthesia.

Results: The forced duction test was positive in all cases, confirming the diagnosis of restrictive strabismus. Uneventful surgery was performed in all cases in which conjunctival adherences to eye orbit bones were eliminated and the involved extraocular muscle was isolated and freed. Furthermore, some additional treatments were applied to avoid recurrency (subconjunctival and topical corticosteroids, amniotic membrane and therapeutic contact lens). One case presented postoperatively a new conjunctival adherence in spite of such anti-recurrency treatment although with no significant motility alterations associated.

Conclusions: Conjunctival surgery can cause fibrosis and conjunctival adherences leading to restrictive strabismus. The surgical procedure for solving this problem must be performed with special care to avoid complications and recurrencies. The use of antimetabolites or amniotic membrane seems to be recommendable to ensure a satisfactory postoperative outcome.