Case Description:A 40-year-old man came to us with protrusion and redness in right eye immediately after undergoing Functional endoscopic sinus surgery .He complained of horizontal diplopia and had right eye exotropia (modified krimsky 40 PD), limitation of adduction not crossing the midline and palpebral fissure widening on adduction, features suggestive of avulsion of right medial rectus. MRI orbit confirmed the clinical findings. Medial rectus(MR) exploration was done. Intraoperatively MR was transected about 15mm from insertion and an attempt was made to bring back the piecemeal posterior edge and reattached to the anterior edge. Diplopia persisted after surgery and patient was given prisms. Eventually a VRT to MR with Foster augmentation was done along with botox to LR. Patient currently has good alignment and no diplopia in primary gaze.Conclusion:A timely exploration and squint correction could provide symptomatic relief and good functional outcome in this challenging case.
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