EPOS

European Paediatric Ophthalmological Society

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Parasympathetic neuropraxia resulting in transient internal ophthalmoplegia after inferior oblique myectomy

Bladen John¹, Moosajee Mariya², Roberts Clare^1
1Chelsea and Westminster Hospital, London, UK, ²Western Eye Hospital, London, UK

Introduction: Internal ophthalmoplegia resulting in pupillary dilatation and loss of accommodation following damage to the ciliary ganglion is very rare after strabismus surgery. Methods: A 12 year old Caucasian girl presented with a V pattern intermittent right/alternating exotropia with bilateral inferior oblique over action. The squint was first seen in infancy but had become increasingly manifest. Bilateral strabismus surgery was carried out under general anaesthesia. Right lateral rectus recession using the anchored hang-back technique, ipsilateral medial rectus resection, and bilateral inferior oblique myectomies were performed. Results: Two weeks after surgery, the ocular alignment had improved but the child complained of slightly blurred vision in the left eye (LogMAR visual acuity at 3m was 0.0 and 0.1 in the right and left eye, respectively) since the operation. Left parasympathetic neuropraxia resulting in transient internal ophthalmoplegia was diagnosed using 0.125% pilocarpine. Short term symptomatic control was achieved with 1% pilocarpine once every 3 days. Over several months, normal function was regained. Conclusion: It is important to check pupillary reflexes pre- and post-operatively. Moreover, there should be an awareness of possible damage to the ciliary ganglion during surgery to the inferior oblique muscle. Thus, patients should be consented appropriately for this complication.