Large Pterygium Excision Resulting In Diplopia

To report a case of a large pterygium excision surgery complicated with post operative simblepharon and restrictive exotropia with diplopia.

Ophthalmology Department of Centro Hospitalar Universitário de São João, Porto, Portugal

A 62-year-old man presented with complaints of progressive visual loss OS over the last year. Presenting VA was counting fingers on OS and on slit-lamp examination a large temporal pterygium extending over the visual axis could be seen. The patient underwent pterygium excision surgery with conjunctival limbal autograft using fibrin glue, which was uneventful. He complied with post-operative eyedrop treatment including topical corticosteroids.

On post-operative follow-up, BCVA was 20/63; however, he complained of diplopia on supradextroversion. On ocular movement assessment, exotropia OS was observed in the primary gaze position with limitation in elevation and adduction of the left eye. Further inspection revealed an inferotemporal symblepharon OS, which progressed over time, resulting in diplopia in the primary gaze position and a restrictive exotropia at 4 months post-op. The patient underwent revision surgery with conjunctival debridement, symblepharon excision, and conjunctival allografting. The procedure was successful in resolving the exotropia and diplopia in the primary gaze position, with only residual limitations in adduction and elevation OS.

Pterygium excision with conjunctival limbal autograft is a first-line treatment as it results in lower recurrence rates compared to other surgical techniques. Symblepharon formation is a rare complication that can lead to motility disturbances due to the attachment of the conjunctiva to the underlying structures. Careful pre-operative evaluation and meticulous surgical technique may help prevent this complication. Nonetheless, patients, especially those with abnormally large pterygiums, should be monitored post-operatively for complications such as diplopia and motility disturbances, as early detection and intervention can lead to better outcomes.