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Anatomical diagnosis
  1. J L Demer
  1. Correspondence to: Joseph L Demer Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 90095-7002, USA; jld{at}

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Important even in strabismus surgery

In the 21st century, it is uncommon for modern general and specialty surgeons to operate without preoperative imaging studies to clarify the anatomy of the surgical site.1 A frequent exception to this rule has been ophthalmology, since direct visual inspection of the beautifully transparent eye permits ophthalmologists to see anatomical detail at exquisite resolution with no more than the array of optical instruments routinely maintained in our offices. Nevertheless, the paper by Ela-Dalman and colleagues, in this issue of BJO (p 682), illustrates the importance of application of modern magnetic resonance imaging (MRI) to the preoperative evaluation of complex strabismus.

Ela-Dalman and colleagues describe two patients in whom complicated endoscopic sinus surgery invaded the orbit and resulted in severe iatrogenic trauma to the medial rectus muscle. Clinical recognition that these patients developed a large exotropia with severe limitation of adduction did not uniquely narrow the differential diagnosis of the strabismus; possibilities included multiple entities requiring differing management. Endoscopic injury to the orbit can avulse or deeply transect extraocular muscles so severely that no recovery would be possible.2 In this event, there is nothing to be gained by delaying definitive treatment, and resorting promptly to nasal transposition of the vertical rectus muscles to …

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  • Grant Support: US Public Health Service, National Institutes of Health, National Eye Institute EY08313, and Research to Prevent Blindness. JLD is Leonard Apt Professor of Ophthalmology.

  • Competing interests: none.

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