Superior Rectus Research Articles

Ocular Motility Abnormalities in Ehlers-Danlos Syndrome: An Observational Study

Purpose: To evaluate ocular motility (OM) abnormalities associated with Ehlers-Danlos Syndrome (EDS). Materials and methods: In this cross-sectional observational study, patients with EDS underwent a complete orthoptic examination. The following orthoptic tests were performed: corneal light reflex test, stereoscopic test, cover test, OM assessment, evaluation of eye pain in different gaze positions and red filter test for diplopia. Results: The corneal light reflex test at 33 cm showed an intermittent divergent deviation in 31.7% of patients and an intermittent horizontal deviation associated with a vertical deviation in 4.9% of patients. A manifest strabismus was observed in 2.4% of patients, whereas 2.4% of patients showed a microstrabismus. The corneal light reflex test at 5 m revealed microstrabismus in 9.8% and manifest strabismus in 2.4% of our patients. Moreover, intermittent exotropia was observed in 2.4% of cases. No significant alterations involving the inferior rectus and the superior oblique muscles were observed. Significant associations were observed between medial rectus muscle deficit of both eyes with pain (p = 0.020) and diplopia (p = 0.014). Furthermore, a significant association between lateral rectus muscle alteration of both eyes and pain was observed (p = 0.004). Conclusions: Our results show various OM alterations in patients with EDS, specifically superior and medial rectus muscle hypofunction. A full orthoptic evaluation in these patients is recommendable to detect OM involvement and possible ligamentous laxity changes over time through an accurate OM assessment.

Modified Nishida Procedure Combined with Lateral Rectus Disabling for Duane Retraction Syndrome

ABSTRACT Duane retraction syndrome (DRS) is a complex congenital cranial dysinnervation disorder. The choice of surgical procedure in esotropic-DRS depends upon several factors that include: the amount of esotropia in the primary position, the presence and severity of palpebral fissure narrowing, globe retraction, presence of medial rectus muscle (MR) contracture, the likelihood of improving abduction, age of the patient, and the presence of binocularity and stereopsis. In the presence of MR contracture, MR recession is performed either alone (unilaterally or bilaterally) or in conjunction with Y splitting plus recession of the lateral rectus muscle (LR) for reducing globe retraction. MR recession, with or without adjustable sutures, may be simultaneously combined with partial thickness vertical rectus muscle transposition (VRT) or with superior rectus muscle transposition (SRT). We describe a novel combination of surgical procedures in the management of esotropic-DRS in two patients. In our first patient, following an initial MR recession combined with LR disinsertion and periosteal fixation (LRDAPF), a modified Nishida procedure was performed. In our second patient following a prior simultaneous MR recession and LR Y splitting with recession, we combined periosteal fixation of the LR with a modified Nishida procedure of the vertical rectus muscles.

Why so low? An unusual case of myositis in a child

BackgroundSarcoidosis is characterized by non-caseating epithelioid granulomas in various tissues throughout the body, most commonly the lung. Non-caseating granulomas may be seen in skeletal muscle, though typically asymptomatic and under-recognized. While rare in children, there is a need to better characterize the disease and its management. Here we present a 12-year-old female with bilateral calf pain who was ultimately found to have sarcoid myositis.Case PresentationA 12-year-old female presented to rheumatology with significantly elevated inflammatory markers and isolated lower leg pain. MRI of the distal lower extremities demonstrated extensive bilateral myositis with active inflammation, atrophy, and to a lesser extent fasciitis. This distribution of myositis in a child garnered a broad differential requiring a systematic evaluation. Ultimately, muscle biopsy revealed non-caseating granulomatous myositis with perivascular inflammation, extensive muscle fibrosis, and fatty replacement of the muscle with a CD4+ T cell predominant, lymphohistiocytic infiltrate consistent with sarcoidosis. Review of histopathology from age 6 of an extraconal mass resected from her right superior rectus muscle further confirmed the diagnosis. She had no other clinical symptoms or findings of sarcoidosis. The patient improved significantly with methotrexate and prednisone, though flared again after self-discontinuation of medications and was subsequently lost to follow-up.ConclusionThis is the second reported case of granulomatous myositis associated with sarcoidosis in a pediatric patient, and the first to present with a chief complaint of leg pain. Increased knowledge of pediatric sarcoid myositis within the medical community will enhance recognition of the disease, improve the evaluation of lower leg myositis, and advance outcomes for this vulnerable population.

Isolated superior rectus muscle hematoma with quiet eye after blunt orbital trauma – A case report

After orbital trauma, medial rectus (MR) and inferior rectus (IR) muscles are the most frequently injured, while the oblique muscles are the least frequently injured. This can be probably because of the anatomical specifications of these muscles within the orbit. It is very unusual to find an isolated muscle injury or hematoma without any other orbital or ocular damage. We report here the case of a 7-year-old boy who presented with an isolated superior rectus muscle (SRM) hematoma after a blunt orbital trauma.

The preliminary discussion about the infraduction following conjoint fascial sheath suspension

BackgroundWe discovered severe ptosis patients developed infraduction after conjoint fascial sheath (CFS) suspension, a complication that is associated with this technique. In this article, the causes and outcomes of the infraduction after CFS suspension were systematically analyzed. MethodsSeventy-four patients with severe ptosis who underwent CFS suspension between February 2020 and June 2021 were reviewed. The palpebral fissure height (PFH), the eyeball position, the infraduction and recovery distance, the eyeball position difference, and the cosmetic results were recorded and analyzed. ResultsBefore surgery, the mean PFH, eyeball position, and cosmetic results were 6.33 ± 0.72 mm, 4.68 ± 0.80 mm, and 2.03 ± 0.96, respectively. The eyeball position difference was 0.70 ± 0.41 mm for unilateral ptosis patients and 0.58 ± 0.26 mm for bilateral ptosis patients. Immediately after surgery, the mean PFH, eyeball position, and cosmetic results were 12.73 ± 1.22 mm (P < 0.0001), 3.01 ± 1.19 mm (P < 0.0001), and 5.80 ± 1.53 (P < 0.0001), respectively. The mean infraduction distance was 1.67 ± 1.04 mm. The mean eyeball position difference was 1.67 ± 1.18 mm (P < 0.0001) for unilateral ptosis patients and 0.83 ± 0.52 mm for bilateral ptosis patients. At the last follow-up, the mean PFH, eyeball position, and cosmetic result were 10.46 ± 1.14 mm (P < 0.0001), 4.19 ± 0.74 mm (P < 0.0001), and 8.24 ± 1.36 (P < 0.0001), respectively. The mean infraduction distance was 0.49 ± 0.48 mm, and the mean recovery distance was 1.18 ± 0.90 mm. The mean eyeball position difference was 0.71 ± 0.61 mm for unilateral ptosis patients and 0.49 ± 0.47 mm for bilateral ptosis patients. ConclusionThe impact on the superior rectus may lead to infraduction after CFS surgery. Patients developed infraduction immediately after surgery and recovered spontaneously. Level of evidenceIV

Surgical management of partial third nerve palsy in a single setting

We report a case of a middle-aged woman who presented to us 8 months after a road traffic accident with the complaint of binocular diplopia. She had limitation of elevation and depression of OD with ptosis, which improved on OD adduction. She underwent (OD) lateral rectus (LR) transposition to superior rectus with Foster augmentation, (OS) LR recession under adjustable suturing technique – 9 mm (5 + 4), and medial rectus (MR) plication 6 mm under local anesthesia. LR was re-recessed by 1 mm the next day. Postoperatively, at 3 months, prism bar cover test showed orthophoria for distance and near in primary gaze with − 3 limitation of elevation in OD.

SUCCESSFUL MANAGEMENT OF HYPERTROPIA RELATED THYROID EYE DISEASE WITH HEMI HANG-BACK PROCEDURE

Introduction: Hypertropia in thyroid eye disease (TED) is uncommon condition which may cause visual and aesthetical problem with quality of life disturbance. Case Illustration: A 44-year-old woman presented with a squint on the right eye with bilateral diplopia for 18 months. She had history of hyperthyroidism for two years which had been treated with thiamazole and propanolol for 1 year and methylprednisolone for 6 months. Visual acuity of both eyes was 20/20 with no sign of active inflammation and optic neuropathy. Ocular motility showed restriction in lateral and down gaze. Inferior restriction was found in forced duction test. Hypertropia of 40 prism diopters was remarkably seen in Krimsky test. We performed strabismus surgery after patient was in inactive stage and reach euthyroid state without treatment for 6 months. During surgery we found muscle enlargement and fibrous tissue of superior rectus muscle. Superior rectus recession for six milimeters with additional hemi-hang back procedure for two milimeters had been performed with significant improvement of diplopia. Ocular motility exercise was suggested to reach binocular vision. Discussion: Hypertropia in TED was caused by extraocular muscle fibrosis due to inflammation and lymphocytic infiltration. Strabismus surgery was aimed at diplopia correction in primary position. Surgical procedure, extra ocular muscles in which surgery must be done and its surgical dosage should be considered carefully. Conclusion: This case showed restrictive hypertropia in TED with distressing symptoms and challenging management. Hemi hang-back procedure is should be considered in difficult case.

Morphological study of extraocular muscles in dissociated vertical deviation by magnetic resonance imaging

Objective: To observe the changes of pulley locations and muscle volumes of extraocular rectus muscles in dissociated vertical deviation. Methods: This was a cross-sectional study. Data was collected from January 2020 to December 2020 in Tianjin Eye Hospital. The pulley locations and muscle volumes of extraocular rectus muscles in DVD patients and healthy volunteers were observed and calculated by continuous coronal MRI scan. One-way ANOVA and independent sample T test were used for statistical analysis. According to the examination results, Groups were divided into A (symmetric DVD), B (asymmetric DVD) and C (healthy volunteers). Data of symmetric DVD patients were divided into dominant eye (A-D) and non-dominant eye (A-nD), while that of asymmetric DVD patients were divided into severe DVD (B-s) and mild DVD (B-m). Volume of 4 rectus muscles and superior oblique muscle were calculated and compared to Group C, respectively. Results: Group A included 5 patients (10 eyes), 2 males and 3 females, aged (22±4) years; Group B included 4 patients (8 eyes), 2 males and 2 females, aged (28±8) years; Group C included 10 patients (20 eyes), including 4 males and 6 females, aged (25±6) years. There was no significant differences in age(F=0.45,P=0.648)or gender(χ2=0.78;P=0.833)among the three groups. There was no significant difference in pulley locations of extraocular rectus muscles between the three groups (FMR=0.52,FLR=0.62,FSR=0.72,FIR=1.16;all P>0.05). Among the four exterocular rectus muscles, the muscle volume of MR [A-D: (562.8±64.4) mm3,A-nD: (560.6±53.2) mm3,B-s: (557.0±48.7) mm3,B-m: (551.5±45.8) mm3], LR [A-D: (519.8±44.5) mm3,A-nD: (511.0±49.4) mm3,B-s: (501.0±35.6) mm3,B-m: (498.3±45.3) mm3] and SR [A-D: (472.8±66.9) mm3,A-nD: (449.4±41.7) mm3,B-s: (433.0±60.8) mm3,B-m: (412.5±54.5) mm3] in group A and group B was higher than that in group C [MR: (423.3±51.9)mm3,LR: (439.7±35.3)mm3,SR: (328.1±36.5)mm3], and the difference was statistically significant (All P<0.05). The inferior rectus muscle volume of dominant eye in group A and mild DVD eye in group B was significantly different from that of healthy volunteers in group C [(453.8±46.8) and (463.0±16.6) vs. (380.4±59.7) mm3, respectively], and the difference was statistically significant (all P<0.05). Conclusions: There are no significant changes in pulley locations of extraocular rectus muscles in patients with symmetric and asymmetric DVD, and the muscle volumes of medial, lateral and superior rectus muscle are greater than those of healthy people. However, the muscle volumes of inferior rectus muscle of dominant eye in symmetric DVD and mild DVD eye are significantly greater.

Computed tomography scan to diagnose abducens nerve palsy cases with superior-compartment atrophy

To use orbital computed tomography (CT) to explore the proportion of superior-compartment lateral rectus muscle atrophy in abducens nerve palsy and its relationship with clinical findings. Twenty-two patients with isolated unilateral abducens nerve palsy were enrolled. Orbital CT scans of all patients were acquired. All measurements were performed in two ways for normal and paretic lateral rectus muscles: posterior volume (mm3) and maximal cross-section area (mm2). These variables were also measured separately in the superior and inferior 40% of the muscle. Primary position esotropia and amount of abduction limitation was also recorded. The mean deviation was 23.4Δ ± 12.1Δ (range, 0Δ-50Δ); the mean limitation of abduction, -2.7 ± 1.3 (range, -1 to -5). Seven cases (31.8%) showed the gross morphologic characteristics of superior-compartment atrophy. In these 7 cases, the mean percentage of atrophy in posterior volume and in maximal cross-section was significantly greater in the superior compartment than the inferior compartment (P = 0.02 for both). The mean limitation of abduction in these 7 cases (-1.7 ± 0.9; range, -1 to -3) was significantly lower than in other cases (-3.1 ± 1.3, range, -1 to -5 [P = 0.02]). In our study cohort, a subgroup of abducens nerve palsy cases demonstrated evidence of superior portion lateral rectus atrophy on orbital CT. The superior-compartment-atrophy group had both a smaller primary gaze esotropia and a smaller abduction deficit, providing evidence that compartmental atrophy should be considered in patients with partially retained lateral rectus function.

Well-Circumscribed Intramuscular Lipoma of Superior Rectus Muscle

Extraocular muscle lipoma is a rare benign mesenchymal tumor of the orbit. We report a case of a 37-year-old woman who presented with chronic progressive proptosis and inferior globe displacement of left eye. External eye examination revealed a yellowish mass at the superior bulbar conjunctiva. Magnetic resonance imaging showed a well-circumscribed mass confined in the superior rectus muscle belly and tendon with a fat signal. Debulking surgery was performed using the transconjunctival and vertical lid split approach. A pathological study demonstrated matured adipose tissue cells encapsulated by a thin layer of fibrous tissue, in addition to the chronic non-specific inflammation of the tenon capsule tissue sample. Histopathological findings of the mass were consistent with a well-circumscribed intramuscular lipoma. The symptoms of the patient were significantly improved 3 months after surgical and short-course systemic steroid treatments. However, long-term surveillance is needed.

Surgical application of Ong speculum in simple limbal epithelial transplantation and pterygium surgery.

Ong speculum is used in glaucoma surgeries such as trabeculectomy to expose the superior part of the globe. The large inferior blade pushes the inferior conjunctival fornix, due to which the eyeball rotates downwards. It has not been used in other anterior segment surgeries before. We used this speculum in simple limbal epithelial transplantation (SLET) and pterygium surgery to expose superior bulbar conjunctiva for harvesting limbal and conjunctival grafts, respectively. As the superior conjunctiva and sclera become exposed, it facilitates the steps of harvesting limbal biopsy and conjunctival graft in SLET and pterygium surgery. This eliminated the need for a superior rectus suture or an assistant who would keep the globe rotated downwards. Its position could also be maneuvered to adjust the site of exposure when dissecting the area of pannus in SLET. Thus, it makes the superior conjunctiva more accessible.

Investigation of Selective Innervation of Extraocular Muscle Compartments.

Recent magnetic resonance imaging studies have suggested that extraocular muscles (EOM) are further divided into transverse compartments that behave differentially and often unexpectedly during eye movements. Selective innervation of EOM compartments may explain the observation that certain horizontal recti compartments contribute to specific vertical eye movements and that some cyclovertical EOM compartments do not contribute to vertical vergence. We investigated the discharge characteristics of extraocular motoneurons during these eye movement tasks where EOM compartments behaved differentially for evidence of selective innervation. We recorded from all six extraocular motoneuron populations in the abducens, oculomotor, and trochlear nuclei as two non-human primates performed vertical vergence and vertical smooth-pursuit. The relationship between motoneuron firing rate, horizontal and vertical eye parameters of the innervated eye during each task was determined using multiple linear regression. All 26 medial rectus motoneurons recorded showed no significant modulation during vertical smooth-pursuit and vertical vergence. Twenty-eight of 30 abducens motoneurons showed no significant modulation during vertical vergence, and all 30 cells did not modulate during vertical smooth-pursuit. For the cyclovertical motoneurons, 147 of the 149 cells (44/46 inferior rectus, 27/27 superior oblique, 41/41 superior rectus and 35/35 inferior oblique) modulated significantly during vertical vergence. Extraocular motoneuron activity during vertical vergence and vertical smooth-pursuit does not support the theory that EOM compartments are selectively innervated. The observed differential behavior of EOM compartments is likely not driven by oculomotor control and could be due to passive change in EOM cross-sectional area.

New Surgical Double Interlacing Technique for Correction of Sixth Cranial Nerve Palsy.

This interventional case series presents a novel surgical procedure involving double interlacing for the correction of esotropia in individuals with sixth cranial nerve palsy. The technique involves first splitting the tendons of the superior rectus, inferior rectus, and lateral rectus muscles. Subsequently, the superior half of the lateral rectus muscle is passed through the undisinserted superior rectus muscle, and the inferior half of the lateral rectus muscle is passed through the undisinserted inferior rectus muscle. Finally, the two halves of the lateral rectus muscle are sutured together and reattached at the original insertion point. The surgical outcomes demonstrate a significant improvement in alignment, abduction, and binocular vision. [J Pediatr Ophthalmol Strabismus. 2023;60(5):e58-e64.].

A Potentially Adjustable Modification of the Nishida Procedure

ABSTRACT For patients with a complete, chronic abducens nerve palsy and resulting abduction deficit, a transposition procedure is often the procedure of choice. One such transposition procedure involves transposing the superior rectus (SR) and inferior rectus (IR) laterally without disinserting or splitting either muscle. While effective, this procedure – like many transposition procedures – carries with it the risk of induced torsional or vertical misalignment. Here, we describe an adjustable variation of the above transposition procedure, one which potentially would allow for post-operative correction of induced vertical or torsional deviations.

Turbo Gradient and Spin-Echo BLADE-DWI for Extraocular Muscles in Thyroid-Associated Ophthalmopathy

Purpose: To investigate feasibility and diagnostic performance of turbo gradient and spin-echo BLADE (proprietary name for Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction [PROPELLER] in Siemens MR systems)-diffusion weighted imaging (TGSE-BLADE-DWI) for depicting extraocular muscle (EOM) involvement and activity in thyroid-associated ophthalmopathy (TAO), and to compare TGSE-BLADE-DWI with readout-segmented echo-planar imaging (RESOLVE). Materials and methods: Thirty-five patients with identified TAO underwent the two DWI scans. Two radiologists visually scored the image quality of the two DWIs with respect to the susceptibility artifacts and geometric distortions on a three-point scale. The maximum size (Sizemax) of EOMs and corresponding ADCs (cADCs) of each patient were compared between the active and inactive phases. The clinical activity score (CAS) was used as a reference to assess the diagnostic performance of EOM ADCs for grading TAO activity. ROC analysis, Pearson correlation, and Wilcoxon signed-rank test were used for statistical analyses. Results: For scores of EOMs, the image quality of TGSE-BLADE-DWI was significantly higher than that of RESOLVE. There were no statistically significant differences between the AUCs of the two DWIs, Sizemax, or cADCs between the active and inactive phases. TGSE-BLADE-DWI ADCs were significantly higher than the RESOLVE ADCs in the right superior rectus, right lateral rectus, left superior rectus, and left inferior rectus. There were no statistically significant correlations between the cADC or Sizemax, and CAS. The highest AUC was 0.697 for RESOLVE and 0.657 for TGSE-BLADE-DWI. The best performing ADC threshold was 1.85 × 10-3 mm2/s with 85.7% sensitivity, 58.8% specificity and 66.67% accuracy for RESOLVE and 1.99 × 10-3 mm2/s with 79.0% sensitivity, and 55.6% specificity and 65.27% accuracy for TGSE-BLADE-DWI. Conclusion: Compared to RESOLVE, TGSE-BLADE-DWI provided improved image quality with fewer susceptibility artifacts and geometric distortions for EOM visualization and showed an equivalent performance in detecting active TAO.

Congenital palsy of the superior rectus muscle - case report

Congenital palsy of the superior rectus muscle - case report

Rescue of exotropia subsequent to pulled-in-two syndrome of the medial rectus muscle occurring during surgery for high myopic strabismus fixus: A case report

Pulled-in-two syndrome is one of the significant complications of strabismus surgery. This study aimed to report a case of pulled-in-two syndrome of the contractured medial rectus muscle (MR) that occurred during strabismus surgery for strabismus fixus due to high myopia, and to describe a rescue of this complication. A woman in her 60s presented to our Ophthalmology Department with the main complaint of unilateral high myopia and severe myopic strabismus fixus. Esotropia exceeded 45° and hypotropia exceeded 15° in her right eye in the Hirschberg test. Right eye duction was markedly limited in every gaze direction. Orbital magnetic resonance images showed rupture of the superior rectus to lateral rectus band ligament and lengthening of the distance between the SR and LR muscles in the right eye. Due to the patient's ophthalmic examination and imaging results, she was diagnosed with high myopic strabismus fixus. We performed MR recession and Yokoyama surgery to correct right eye hypoesotropia. In the MR recession procedure, pulled-in-two syndrome (MR muscle tear) occurred. Thus, no additional procedure was performed on the MR. After the surgery, she presented 45 prism diopter exotropia and 18 prism diopter residual right hypotropia in a Krimsky test. We performed a second surgery, combining MR muscle advancement and inferior rectus (IR) muscle recession, 3 months after the first surgery. One and a half years after the second surgery, she presented exotropia of 14 prism diopters without hypotropia in the Krimsky test and was satisfied with her ocular position and improved motility. We experienced pulled-in-two syndrome in a case with severe myopic strabismus fixus and achieved a good outcome by performing additional surgery 3 months later, in which the lost MR muscle was advanced. This case underscores that, if the lost muscle cannot be found during surgery, one should maintain composure and perform a reoperation a few months after the initial surgery, if necessary. This case report can aid in making rescue treatment decisions when pulled-in-two syndrome occurs.

Multidisciplinary evaluation of orbital floor fractures: dynamic MRI outcomes

ABSTRACT Purpose Orbital floor fractures can cause functional disorders such as limitation of ocular motility. The dysfunction of the extrinsic muscles was studied with the Hess-Lancaster test; although we expected a large percentage of inferior rectus muscle dysfunction, the results showed 52% superior rectus muscle dysfunction. Methods In light of these results, we began testing five patients with functional deficits evidenced by the Hess-Lancaster test with magnetic resonance imaging to assess the change in thickness of the affected muscle compared to the contralateral healthy muscle during standardized eye movements. Results This investigation showed an increase in the size of the inferior rectus muscle on the affected side during the fraction of time when the patient was asked to look up, probably due to post-traumatic fibrosis. According to our hypothesis, muscle thickness would condition the correct release of the inferior rectus muscle to such an extent that it would also influence the contraction of the superior rectus muscle, which would then be deficient. Conclusions Based on our experience, a multidisciplinary approach and longer follow-up with thorough investigations should be considered for patients with orbital floor fractures. Furthermore, our results suggest the need for early surgical treatment, in contrast to current guidelines that aim to delay restorative surgery.

No-split, no-tenotomy transposition of only the superior rectus muscle combined with medial rectus recession in patients with complete abducens nerve palsy

To evaluate the outcomes of no-split, no-tenotomy transposition of only the superior rectus muscle combined with medial rectus recession in patients with complete abducens nerve palsy. In this procedure, the temporal margin of the superior rectus muscle, 10 mm posterior to the insertion, was secured with a nonabsorbable suture and sutured to the sclera at a distance of 12 mm from the limbus in the superotemporal quadrant, halfway between the superior rectus and lateral rectus. Success was defined as distance and near alignment of ≤8Δ and no diplopia in primary position 6 months after surgery. A total of 8 patients with abducens nerve palsy underwent the procedure. At the last follow-up, the mean postoperative change in primary position deviation was 42.6Δ ± 8.1Δ (range,34Δ-57Δ) for distance and 42.1Δ ± 7.5Δ (35Δ -57Δ) for near, a significant reduction (P = 0.012). Abduction deficit also improved significantly (P = 0.010). Postoperatively, no vertical deviation or torsional diplopia was induced. At the 6 months' follow-up, compared with the first postoperative visit, an esodrift at near developed in 1 patient. Of the 8 cases, 6fulfilled the criteria for success. In our small study cohort, no-split, no-tenotomy superior rectus transposition and medial rectus recession improved esotropia and abduction limitation without inducing significant vertical deviations or torsional diplopia.

Comparative Assessment of Short-Term Tendon-Scleral Postoperative Inflammation and α-Smooth Muscle Actin Expression following Oral and Topical Diclofenac Administration for Strabismus Surgery in Rabbits

PurposeWound healing and fibrosis modulation are considered pivotal for the long-term outcome of strabismus surgery. Nonsteroidal anti-inflammatory drugs, including diclofenac sodium, are inflammation suppressive drugs that may modulate wound healing, including postoperative inflammation. This study aimed to compare the effect of oral and 0.1% topical diclofenac sodium on short-term inflammation and α-smooth muscle actin (α-SMA) expression at the tendon-scleral attachment site following strabismus surgery in an experimental rabbit model.MethodsSuperior rectus recession was performed in 12 eyes of six New Zealand rabbits. Rabbits were divided into three groups: oral diclofenac 2 × 5 mg/kg for three days (group A), 0.1% diclofenac sodium eye drops 3 times/day for three days (group B), and controls (group C). On postoperative day 14, enucleation was performed. Macroscopic adhesion score, microscopic adhesion score, percentage of postoperative inflammation area (Masson’s trichrome staining), and α-SMA (immunohistochemistry staining) were assessed. Data analysis was performed using a semi-quantitative and quantitative assessment with ImageJ. All groups were compared with reciprocal staining intensity (RSI) values to measure α-SMA expression.ResultsAll groups showed no difference in macroscopic (p = 0.13) and microscopic adhesion scores (p = 0.28). The percentage of postoperative inflammation area in group B (12.44% (8.63–18.29)) was significantly lower than group A (26.76% (21.38–37.56) p = 0.03) and group C (27.80% (16.42–36.28), p = 0.04). Comparative RSI analysis found that group B had a significantly lower α-SMA expression than group C (174.08 ± 21.78 vs 212.58 ± 12.06, p = 0.04).ConclusionThe results suggest that compared to oral, the administration of topical diclofenac showed a more significant reduction of short-term postoperative inflammation and α-SMA expression at the tendon-scleral attachment site following strabismus surgery.