Treatment of Extreme Strabismus in TAO (Thyroid-Associated Orbitopathy): Medial Rectus and Inferior Rectus Tendon Elongation As an Alternative to Conventional Strabismus Surgery: a Case Report

Introduction

Patients with Thyroid associated orbitopathy (TAO) often present large squint angles, especially following decompression surgery of the medial orbital wall. Esotropic angles up to about 45 prism diopters (PD) may be treated with conventional bilateral recessions of the tight medial rectus muscles up to 6–7 mm, the amount that is usually considered the maximum dosage. Tendon elongations with Tutopatch® have already been reported as a good option to treat large vertical angles in TAO [1], suggesting that this is also a good option for recessions of the medial rectus muscle exceeding 7 mm. Here, we present a case of a patient with an extremely large horizontal and vertical squint angle.

• References

• 1 Esser J, Schittkowski M, Eckstein A. [Gravesʼ orbitopathy: inferior rectus tendon elongation for large vertical squint angles that cannot be corrected by simple muscle recession]. Klin Monatsbl Augenheilkd 2011; 228: 880-886
• 2 Kahaly GJ, Pitz S, Hommel G. et al. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Gravesʼ orbitopathy. J Clin Endocrinol Metab 2005; 90: 5234-5240
• 3 Eckstein A, Esser J. [Endocrine orbit disorders. Pathogenesis, clinical presentation and examination, stage-dependent therapy]. Ophthalmologe 2003; 100: 857-880
• 4 Van Rijn LJ, van De Ven SJ, Krijnen JS. et al. Tendon elongation with bovine pericardium (Tutopatch®) when conventional strabismus surgery is not possible. Eur J Ophthalmol 2016; 26: 193-202