Abstract
The authors report a case of a 69 year-old woman who developed persistent vertical deviation and diplopia after extracapsular cataract surgery and had a positive past history of thyroid disease. The authors emphasize the need of for detailed orbit propedeutics in order to rule out restrictive strabismus associated with post-facectomy diplopia.
Highlights
P ost-facectomy diplopia without complications is a disappointing event for the surgeon.(1) When such a situation is monocular, it can be explained by uncorrected refractive errors, maculopathy, corneal irregularities or intraocular lens.On the other hand, when it is binocular, it can be related to anisokonia or loss of ocular alignment.This loss occurs due to decompensation of previous phorias, restrictive mechanisms, paralysis, myasthenia gravis and skew-deviation(2)
The vertical diplopia after peribulbar or retrobulbar anesthesia can cause paresis, contractures and hyperfunction(3), and has incidence after cataract surgery estimated in 0.3%, which can be explained by five mechanisms:anisokonia, prior diplopia masked by visual impairment, damage to the extraocular muscles by sutures in the perioperative period, allergic or toxic reaction to anesthetic agents, and direct trauma to muscles by anesthetic block(1,4)
The patient in the present case report denied previous diplopia.Her past medical history showed hyperthyroidism treated with radioactive iodine and which currently was under control with the use of Puran-T4.Restriction of the extraocular muscles produce incomitant heterotropias with limitation of ductions, and may be caused by dysthyroid orbitopathy, trauma, orbital tumors, etc.(2)
Summary
P ost-facectomy diplopia without complications is a disappointing event for the surgeon.(1) When such a situation is monocular, it can be explained by uncorrected refractive errors, maculopathy, corneal irregularities or intraocular lens.On the other hand, when it is binocular, it can be related to anisokonia or loss of ocular alignment.This loss occurs due to decompensation of previous phorias, restrictive mechanisms, paralysis, myasthenia gravis and skew-deviation(2). The vertical diplopia after peribulbar or retrobulbar anesthesia can cause paresis, contractures and hyperfunction(3), and has incidence after cataract surgery estimated in 0.3%, which can be explained by five mechanisms:anisokonia, prior diplopia masked by visual impairment, damage to the extraocular muscles by sutures in the perioperative period (making reins), allergic or toxic reaction to anesthetic agents, and direct trauma to muscles by anesthetic block(1,4). The authors discuss the possible causes of vertical diplopia after cataract surgery in patients with previous positive history of thyroid disease
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