J Korean Ophthalmol Soc.  2014 Mar;55(3):408-415. 10.3341/jkos.2014.55.3.408.

Fixation of the Eyeball to the Periosteum Over the Posterior Lacrimal Crest in Inveterate Exotropia

• Seol BR
• Khwarg SI
• Kim SJ

• KMID: 2218271
• DOI: http://doi.org/10.3341/jkos.2014.55.3.408

Abstract

PURPOSE
To report the results obtained after fixation of the eyeball to the periosteum over the posterior lacrimal crest in 5 cases of inveterate exotropia.
METHODS
From September 2011 to January 2013, 5 patients with inveterate exotropia and a history of surgery for exotropia underwent fixation of the eyeball to the periosteum over the posterior lacrimal crest.
RESULTS
The mean preoperative exotropia of 35 +/- 10.61 PD changed to esotropia of 5.8 +/- 17.28 PD at the one week postoperative visit and exotropia of 13.2 +/- 11.34 PD at the final postoperative visit (mean, 6.05 months after surgery). At the final postoperative visit, 2 patients who had ocular adhesion due to trauma showed 25 PD exotropia. None of the patients showed injuries to the lacrimal system, but 2 patients showed conjunctival granuloma.
CONCLUSIONS
Fixation of the eyeball to the periosteum over the posterior lacrimal crest is an effective approach for the management of inveterate exotropia, except in cases of exotropia combined with ocular adhesion.

Keyword

Inveterate exotropia; Periosteal fixation; Precaruncular

MeSH Terms

Esotropia
Exotropia*
Granuloma
Humans
Periosteum*

Figure

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  Figure 1. Schematic drawings of surgical procedures. (A) Conjunctival incision is made at the nasal quadrant of the eyeball and tenon dissection is done. Medial rectus muscle is isolated using the muscle hook. (B) 1% lidocaine mixed with epi-nephrine (1:100000) is injected and transcaruncular conjunctival incision is made. (C) Dissection is performed posteriorly and na-sally to reach the periosteum with Colorado needle monopolar electrocautery. (D) Periosteum over posterior lacrimal crest is sutured with 5-0 double armed non absorbable braided polyester (Ethibond®). (E, F) 18 gauge needles are passed through the subtenon space and tracted laterally. (G) Passed needles are se-curely anchored to the sclera at the insertion site of medial rectus muscle. (H) The sutures are tightened. (I, J) Medial peril-imbal sclera is anchored with 6-0 black silk. The sutures passed through medial part of upper eyelid and tided.

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  Figure 2. Case 5. The preoperative 9 gaze photograph shows third nerve palsy in the left eye. The patient had ptosis and mild dilated pupil in the left eye and left exotropia in the primary position.

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  Figure 3. Case 5. The 9 gaze photograph of postoperative 15 months shows mild exotropia in the primary position.

Reference

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