Special consideration while planning exotropia surgery in high myopic adults

Aim To follow a new parameter in managing exotropia in high myopic adults. Patients and methods This study included 30 adult patients, having high myopia, more than −8 D in one or both eyes, and suffering from exotropia. The exotropia is investigated, whether axial or curvature, by measuring the axial length in both eyes, and studying the corneal curvature, and the angle of exotropia was measured for distance and for near. In this study, after excluding restrictive strabismus, the largest angle of exotropia, is targeted, but the choice of surgery was always plication of medial recti muscles, whether one or two depending on the angle to be corrected and the eye with exotropia, avoiding recession of lateral recti, even if divergence excess, so avoid postoperative bad cosmesis that results from muscle recession, causing some proptosis and widening of palpebral fissures which are not satisfying to the patients, keeping recession of lateral recti for residual exotropia after plication of medial recti. Results Exotropia was corrected in all cases, without postoperative widening of the palpebral fissure height, by using the medial rectus muscle plication for strengthening the medial recti muscles. Two cases of residual exotropia required a second surgery, lateral rectus weakening, performed by hang back technique, avoiding accidental scleral path. Conclusion Strengthening of the medial recti muscles in high myopic exotropic patients was found to be a surgical technique without the known complication of postoperative widening of vertical palpebral fissure height and also without any problem of intrascleral path that could happen when recessing lateral recti muscles in high mopes with thin sclera.