Aetiology, clinical features and surgical outcomes of isolated medial rectus palsy

Abstract

Importance Isolated medial rectus palsy is extremely rare in clinical practice. Background To report demographics, aetiology, clinical findings, imaging features and surgical outcomes in patients with isolated medial rectus palsy. Design Retrospective study. Participants All patients treated for isolated medial rectus palsy at Zhongshan Ophthalmic Center, Sun Yat‐sen University, between September 2003 and March 2019. Methods Review of patient records. Main Outcome Measures Aetiology, clinical findings, imaging features and surgical outcomes. Results A total of 32 patients (22 males, 10 females) were included. Mean age was 33.19 ± 19.78 years. The right eye was involved in 17 patients, the left eye was involved in 14 patients, and both eyes were involved in one patient. The most common causes were iatrogenic injury (43.75%), followed by trauma (37.50%) and congenital (18.75%). The most common clinical findings included outward deviation, diplopia and limited adduction. Six patients showed combined small‐angle vertical strabismus, and 10 patients experienced a scale of −1 motility defect in other directions. After individualized strabismus surgery, preoperative exotropia of 60 ± 25 prism diopters (PD) was significantly reduced to 12 ± 13 PD (t = 10.938, P < .0001). Ocular motility improved in 21 patients, and five patients achieved normal ocular motility. Successful correction was obtained in 20/32 (62.50%) patients, with under‐correction in 12/32 (37.50%) patients. Twenty‐eight patients had only one surgery, three patients had two surgeries and one patient had three surgeries. Conclusions and Relevance The most common cause of isolated medial rectus palsy was local injury. Satisfactory results were obtained after individualized surgical interventions based on personalized preoperative evaluations.

Congenital dysplasia involving both medial and inferior recti: clinical features and surgical outcomes

“…These findings contributed to the validation of extraocular muscle dysplasia diagnosis (Figure 1D). DISCUSSION Strabismus related to congenital abnormalities of extraocular muscles have been reported in previous literatures [6,[13][14] . Simultaneous congenital dysplasia involving both MR and IR muscles is extremely rare.…”

“…C ongenital dysplasia of extraocular muscles, as can result from embryonic mesodermal lesions of unknown origins, represents a rare congenital anomaly. Although congenital dysplasias or isolated absences of inferior recti (IR) and medial recti (MR) muscles have been reported in the literature [1][2][3][4][5][6] , to our knowledge, no paper on congenital dysplasia simultaneously involving MR and IR muscles currently exists. Thacker et al [7] reviewed four cases with simultaneous MR and IR paresis; however, all of these cases were complicated due to endoscopic sinus surgery.…”

Isolated Medial Rectus Palsy in a Patient After Percutaneous Transluminal Coronary Angioplasty

“…In the medical literature, only 59 occurrences of isolated medial rectus palsy have been documented, with the majority of them being single case presentations. This indicates how uncommon isolated medial rectus palsy presentations are in clinical practice [7][8][9][10][11][12][13][14][15][16][17]. Unilateral ocular palsy is typically associated with orbital lesions or muscular illnesses, and seldom with a nuclear lesion of the III nerve, while inferior oblique muscle palsy due to intermediate subnuclei lesions is more prevalent [18].…”