Treatment of subtotal medial rectus myectomy complicating functional endoscopic sinus surgery

During the past 2 decades, the introduction of functional endoscopic sinus surgery (FESS) has dramatically improved the treatment of sinus disorders. However, a variety of orbital complications have been reported, including o ptic nerve damage, hemorrhage, infection, compromise of the lacrimal draina ge apparatus, and strabismus. At least 10 cases have reported damage to the medial rectus muscle.(1-8) Treatment options for such patients have been l imited, especially because most are adults at risk for anterior segment isc hemia after transposition of vertical rectus muscles. We describe 2 patient s whose medial rectus myectomies were repaired by using nonabsorbable "hang -back" sutures in combination with a botulinum toxin (Botox) injection of t he antagonist lateral rectus muscle. Good primary position alignment was ac hieved in both patients, and one patient was able to regain binocular funct ion. We recommend this surgical approach, especially in patients at increas ed risk for anterior segment ischemia.