This is a case report of bilateral extraocular muscle epithelial inclusion cysts found in the body of the muscle, not just involving the tendon or the new tendon–scleral interface, after strabismus surgery in a 3-year-old boy with consecutive exotropia. Histologic review of the cysts confirmed the presence of inclusion cysts originating from proliferating conjunctival epithelium occurring in the body of both medial rectus muscles. We postulated that the occurrence of bilateral inclusion cysts might have caused the persistent postoperative localized inflammatory response. Epithelial inclusion cysts are often noted in periocular locations such as the conjunctiva, caruncle, eyelids, and cornea. Rarely are they noted in the body of an extraocular muscle. 1 Histologically, epithelial inclusion cysts are nests of proliferating epithelial cells with a laminated keratinized center of sloughed cells. Etiology is attributed to viable epithelial cells being displaced into the subdermal, subconjunctival, or episcleral space as a complication of surgery, inflammation, or both. 1,2 We present what to our knowledge is the first reported case of bilateral extraocular muscle inclusion cysts after strabismus surgery. CASE REPORT A 3-year-old boy had consecutive exotropia that developed after bimedial rectus recession at 7 months of age to treat infantile esotropia. Postoperative inflammation was treated with 3 weeks’ administration of prednisolone acetate (Pred Forte; Allergan, Irvine, CA) 4 times per/d. Ten months after surgery, intermittent consecutive exotropia manifested when the patient was fatigued. A small inflammatory nodule existed in the right eye, and the patient was restarted on Pred Forte drops 3 times/d for 3 weeks. When we saw the patient, 28 months after bimedial rectus recession, our impression was exotropia (20 prism diopters) with right hypertropia (10 to 15 prism diopters), worse on right gaze (Fig 1). His visual acuity was 20/30 OD, 20/30 in the left eye OS, and 20/20 OU. A mass was noted in the right nasal area per both gross and slit lamp examination. This mass was in the area of his previous medial rectus insertion and appeared to present a mechanical obstruction to complete adduction of the right eye. Versions were otherwise normal in the right eye as well a the left eye. We performed the patient’s surgery when he was 3 years old, at which time we encountered a sub-Tenon’s cyst in the right eye. The cyst measured 5.0 mm in height, and it covered the tendon and muscle body of the recessed medial rectus (Figure 1, top). The cyst was dissected free