title: Restrictive Strabismus and Diplopia 2 Years After Conjunctivodacryocystorhinostomy With Medpor-Coated Tear Drain.
abstract: A 19-year-old woman who underwent conjunctivodacryocystorhinostomy with Medpor-Coated Tear Drain 2 years ago presented with diplopia on left gaze for 4 months. Limitation of extraocular movement of OS on left gaze was observed on duction test. The forced duction test revealed restriction of the left medial rectus muscle. Orbital MRI demonstrated an enhancing soft tissue lesion surrounding the tube in inferomedial aspect of left orbit. Removal of the tube and adhesiolysis were performed. Histologic findings were consistent with a chronic inflammation with fibrosis. After surgery, limitation of extraocular movement and diplopia were completely resolved. Jones tube coated with a thin layer of porous polyethylene allows the ingrowth of fibrovascular tissue into the coating, decreasing the probability of tube extrusion, but can also accelerate fibrotic changes around the tube causing restrictive strabismus.
authors.affiliation: *Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; †Department of Ophthalmology, Gangneung Asan Hospital, University of Ulsan, College of Medicine, Gangwon, Korea; and ‡Plastic and Reconstructive Surgery, Johns Hopkins Hospital, The University of Maryland Medical System, Baltimore, Maryland, U.S.A.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Shin
authors.forename: Yoon-Duck
authors.initials: YD
authors.lastname: Kim
authors.forename: Chung-Hyun
authors.initials: CH
authors.lastname: Lee
authors.forename: Owen N
authors.initials: ON
authors.lastname: Johnson
authors.forename: Kyung In
authors.initials: KI
authors.lastname: Woo
mesh_terms: D020099:Coated Materials, Biocompatible; D003228:Conjunctiva / Q000601:surgery*; D003608:Dacryocystorhinostomy / Q000295:instrumentation*; D004172:Diplopia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007440:Intubation; D008279:Magnetic Resonance Imaging; D013508:Ophthalmologic Surgical Procedures; D011095:Polyethylenes; D011183:Postoperative Complications; D019736:Prostheses and Implants / Q000009:adverse effects*; D013285:Strabismus / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
chemical_list: D020099:Coated Materials, Biocompatible; C084562:Medpor; D011095:Polyethylenes