2.7\ Strabismus Surgery

2.7.1\ Discussion

Strabismus secondary to cranial nerve palsy can be treated by rectus muscle transposition. Several techniques can be performed, including repositioning portions of the rectus muscle bellies onto the sclera, with or without tenotomy (Fig. 2.24).

The effects of rectus transposition can be appreciated on imaging, including changes in size as morphology of the rectus muscles and signal alterations on MRI. Although improved ocular alignment can also be noted on imaging, this is readily assessed on clinical exam. Nevertheless, imaging can be useful for evaluating postoperative complications, such as rectus muscle rupture (Fig. 2.25) and infection (Fig. 2.26).

Fig. 2.25  Postoperative rectus muscle rupture. The patient presented with recurrent right exotropia after bilateral medial rectus resections. The right medial rectus muscle was noted to be friable intraoperatively. Axial T2-weighted (a) and T1-weighted (b) MR images show

an abrupt caliber change and signal abnormality in the belly of the right medial rectus muscle (arrow). The distal portion of the right medial rectus is lax, and there is lateral rotation of the globe. Bilateral lens implants are also present