Upper eyelid retraction and superior recti stretched scar.
Juliana Albano de Guimarães, Christine M Morello Abbud
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Case in brief
A 26-year-old woman presented with four years of upper eyelid retraction and exotropia, five years after bilateral medial and superior rectus recessions for esotropia and dissociated vertical deviation. Evaluation for thyroid eye disease was negative. Surgery revealed stretched scars in both superior recti and the left medial rectus. The scarred segments were excised and the muscles reattached to the sclera. At one-year follow-up, she was orthotropic and the eyelid retraction had resolved.
What made this case unusual
The case links upper eyelid retraction to stretched scars in previously recessed superior rectus muscles, an association with only a few prior reports described by the authors.
Diagnostic / clinical pearl
In a patient with eyelid retraction and strabismus after superior rectus recession, consider stretched muscle scars, particularly when evaluation for thyroid eye disease is negative.