Exotropia

A 19-year-old girl presented with large-angle V-pattern exotropia. She was a known case of Treachery Collins syndrome. On examination, she had downward slanting palpebral fissures, micrognathia, microtia, maxillary hypoplasia and zygomatic hypoplasia. She had undergone right lower lid coloboma repair 4 years prior.

Examination

On examination, best-corrected visual acuity was 6/18 in the right eye and 6/12 in the left eye. The refraction was found to be –3.5 dioptres cylinder (DC) at 180 degrees in the right eye and –1.75 DC at 180 degrees in the left eye. The patient had 70 prism dioptres (PD) of exotropia with a V pattern. Ocular motility was full and free on ductions and versions. MRI orbit did not show any abnormalities in the extraocular muscles position.  Postoperatively, the patient was prescribed topical steroids, antibiotics and lubricants as per hospital protocol. She had a residual exotropia of 30 PD in the subsequent follow-up visits. Second-stage surgery was performed 6 months later. Right eye 3 mm LR re-recession and 2 mm MR re-resection with left eye MR resection 6 mm was done. A week following the second surgery, the patient presented with congestion, chemosis over the medial rectus and mild purulent discharge in the left eye. She was started on oral antibiotics. Topical steroids and antibiotics were continued in both eyes. Five days later, she returned to the clinic with a ruptured subconjunctival abscess in the left eye, just posterior to the medial rectus insertion.