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Incomitant Esotropia Secondary to Lateral Rectus Injury

Correspondence: Requests for reprints should be addressed to: Mitchell B. Strominger, M.D., Tufts – New England Medical Center, 750 Washington St, Box 450, Boston, MA 02111.

Incomitant esotropia simulating a sixth nerve palsy from lateral rectus injury is an unusual diagnosis. Two patients are presented both with abduction defects thought secondary to either a restrictive orbitopathy or sixth nerve palsy. Force generation testing revealed a paretic process. Neuroimaging demonstrated transection of the lateral rectus muscle in both patients. One was secondary to a lateral wall fracture and the other iatrogenic during lateral wall decompression surgery for thyroid orbitopathy. Lateral rectus injury should be considered in patients with a history of trauma or orbital surgery. Forced duction and generation testing, and neuroimaging can reveal the diagnosis.

Key words: esotropia, lateral rectus injury