Dr. Hemalatha, Dr. Sowbhagya H N
A 26year female came with left eye deviation since birth,diminition in vision,ptosis,with negative family history.General examination was normal.Ocular examination showed BCVA 6/9 right eye and counting fingers close to face-left eye,60PD left exotropia,20PD hypertropia,severe left ptosis,poor levator function,lagophthalmos,poor bells phenomenon,rotatory nystagmus.Left eye forced duction test positive for lateral and superior rectus.Surgery done for cosmesis.Intraoperatively fibrotic tenons,abnormal muscle insertions,fibrofatty infiltration of muscle belly found.Phase1 maximal lateral rectus recession,superior rectus tenotomy,phase2 medial rectus resection,inferior rectus resection with superomedial transposition done.Residual 8PD hypertropia and ptosis surgery planned later.Hence unilateral supraducted ptotic eye,with restrictive ophthalmoplegia considered in CFEOM presentation.Multiphased surgery may be required.Residual deviation may persist.Amblyopia heeded to by early treatment.