Aetiology and management of the 'detached' rectus muscle.

Abstract

The clinical features and management of 17 cases of detached extraocular muscles are described. They are classified into four groups: (1) the muscle which is cut and lost during squint surgery, (2) the muscle which breaks during squint surgery, (3) the muscle which slips following squint surgery, and (4) the muscle which is damaged during facial or orbital trauma. The prognosis for group 1 is poor whereas groups 2-4 have a good chance of successful muscle relocation. Figure 2 The muscle which snaps leaves a small tuft of insertion attached to the eye. who presented to or were referred to any of the authors with a detached rectus muscle. These patients were referred either at the time of surgery, postoperatively, or in the period following injury.Patients belonged to one of the following four groups. GROUP 1 Cases in which the muscle was inadvertently cut free from the globe and lost during squint surgery (Fig 1)

Traumatic tear of the inferior rectus muscle treated with inferior oblique anterior transposition

“…Aggressive orbital dissection should be avoided because this may result in laceration of Tenon's capsule with manipulation of orbital fat and, consequently, the development of a fat adherence syndrome [1,3]. The most indicated repair technique in a case treated soon after the injury is reattachment of the torn ends of the muscle.…”

“…However, these procedures carry an increased risk of anterior segment ischemia, especially in older patients [1,3]. IOAT, first described by Elliot and Nankin in 1981 [8], might be an alternative treatment in these cases.…”

“…The tearing can occur in the insertion of the muscle, the so-called ''lost'' rectus muscle syndrome, or across its width, usually at the junction between muscle and tendon [1].…”

A conventional strabismus surgical approach for lost medial rectus muscles

“…[1][2][3] Medial rectus (MR) muscles lost during strabismus surgery are rarely found. 4 A lost MR muscle is usually expected in the presence of an overcorrection after esotropia (ET) surgery or undercorrection after exotropia (XT) surgery, resulting in limited duction in the field of action of the muscle. We present 3 cases of successful conventional strabismus surgery to retrieve lost MR muscles.…”

Vertical Muscle Transposition with Augmentation for Treatment of Exotropia Caused by Iatrogenic Lost Medial Rectus Muscle

“…Plager & Parks (1990) reported that 67% of lost superior, inferior, and lateral rectus muscles were retrievable while only 10% of lost medial rectus muscles were retrievable. MacEwen et al (1992) found that medial rectus muscles that were cut and lost during strabismus surgery are seldom located, but snapped or traumatically severed muscles are frequently located.…”