Strabismus Surgery in a Case of Near Reflex Substitution for Horizontal Gaze Palsy

To report the result of strabismus surgery in a case of near-reflex substitution for horizontal gaze palsy.

The patient was a 9-year-old girl with esotropia of 35 PD, right face turn, and right side facial palsy. Ocular motility examination was remarkable for right side gaze palsy and on attempting right gaze, all components of near reflex, including a convergence movement as well as bilateral pupillary miosis and myopic shift, were manifested. Her deviation was manifested after the first episode of intraventricular hemorrhage at the age of one month. Clinical and imaging findings were consistent with right side facial colliculus syndrome with near reflex substitution. We performed a right medial rectus muscle recession and a half-tendon transposition of the superior and inferior recti muscles to the right lateral rectus muscle insertion, which resulted in orthophoria in primary position, improvement of the right face turn, and substantial decrement of convergence movement.

Near reflex substitution for the horizontal gaze palsy in a patient with other features of the facial colliculus syndrome has rarely been reported. Eye muscle surgery did reduce the paradoxical convergence movement but did not significantly improve the other components of the substituted near reflex.