case_images: PMC6533447_01
case_images: Pre- and postoperative clinical photographs of the conjunctiva of the right eye.. 1a: Preoperative photograph showing diffuse congestion and bogginess of the conjunctiva. A large subconjunctival nodule in the inferotemporal area is marked with an arrow. . 1b: Postoperative photograph 3 weeks after the strabismus surgery showing marked reduction in conjunctival congestion. The arrowhead shows congestion around the 6-0 Polyglactin suture anchoring the lateral rectus muscle. . 1c-1d: Postoperative photographs 3 and 13 months after the surgery. Few persistent small cysts in the inferior quadrant are marked with black circles.
case_images: OC-09-12-g-001.jpg
case_images: PMC6533447_01_OC-09-12-g-001.jpg
case_images: F1
case_images: They were predominant in the superotemporal and inferotemporal quadrants (Figure 1a (Fig. 1)). The conjunctival inflammation gradually reduced (Figure 1b-d (Fig. 1)) eliminating the ocular discomfort.
case_images: Intraoperative photographs showing the various steps of the strabismus surgery. . 2a-g: Intraoperative photographs of the surgical field of lateral rectus recession. 2a: Multiloculated cyst encountered just beneath the conjunctival incision. 2b: Large uniloculated cyst (+) located within the anterior tenon's capsule at the superior edge of the lateral rectus muscle. 2c: Small SiO cysts (arrows) embedded within the muscle sheath. 2d: SiO cysts located beneath the muscle (arrow head) in the episleral tissue. 2e: Shows the surgical field after separation of tenon's capsule (i) from overlying conjunctiva (ii) and underlying LR muscle (iii). The thickened tenon's fascia embedded with multiple small cysts can be appreciated. 2f: Shows resection of tenon's fascia overlying the LR muscle. 2g: Shows sliding noose adjustable hangback recession of LR. 2h: Intraoperative photograph of the medial rectus resection showing a relatively clear surgical field.
case_images: OC-09-12-g-002.jpg
case_images: PMC6533447_01_OC-09-12-g-002.jpg
case_images: F2
case_images: Numerous cysts were found embedded within the tenon's capsule, the muscle sheath, and under the LR muscle (Figure 2a-d (Fig. 2)). This had rendered the tenon's fascia thick and fibrosed (Figure 2e (Fig. 2)). The muscle sheath and portion of the tenon's fascia surrounding the muscle had to be resected to remove the cysts and facilitate isolation of the muscle (Figure 2f (Fig. 2)). After securing the LR with 6-0 polyglactin suture, it was recessed 6.5 mm using a sliding noose adjustable suture technique (Figure 2g (Fig. 2)). Thereafter, medial rectus muscle resection (4.5 mm) was performed (Figure 2h (Fig. 2)).