I was referred a patient by a senior from New Delhi and when I examined the lady, I understood that this was no straight forward situation. It was a young woman in her early 20’s who had just delivered a healthy baby girl. Unfortunately for her, during the delivery she had a bleed in the brain and that left her with a left eye abducens nerve paralysis (Lateral rectus muscle paralysis) and a left gaze palsy. Her eyes would not move to the left side at all and the left eye was deviated inwards (convergent squint).  There was a squint and she was having a double vision. She came to me after about 6 months after the brain haemorrhage and had shown little recovery during this period. I evaluated her and found that there was need to do surgery to correct her squint and help her get rid of the double vision because she was extremely distressed by it.  

Eyes Before squinting surgery I performed a surgery in the left eye called a split vertical rectus transposition procedure where I augmented the force of the paralyzed lateral rectus muscle by shifting two vertical rectus muscles to the insertion of the lateral; rectus muscle after splitting them into half. In addition, I had to put two special sutures called the Foster sutures to ensure proper direction of force of the split vertical rectus muscles. I also weakened the left medial rectus muscle by a recesssion procedure. After the squint surgery, the eyes became straight and the squint disappeared. Surprisingly, there was some improvement in the eye movements and gaze palsy also.

 

Eyes After squinting surgery

Now after 2 years of her surgery, she does not suffer from double vision and the squint is completely corrected. She tells me that she really enjoys playing with her 2.5 year old daughter and is happy her eye problem is over.