Congenital dystrophic medial rectus muscles
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Congenital absence of the rectus muscles of the eye is rare. Most of these cases are associated with one of the craniofacial syndromes, the superior rectus or the superior oblique is commonly missing. The absence of the inferior rectus muscle and its management has also been reported in the literature. We report two patients, one with congenital dystrophic medial rectus muscles and one with the absence of the medial rectus muscles; in addition, one of them had an absence of the lateral rectus muscles. While the absence of the superior oblique and superior rectus has been more commonly reported in the literature, especially with craniofacial syndromes, our patients were nonsyndromic. Considering the risk of anterior segment ischemia, correction of the large angle exotropia was performed by horizontal rectus muscle surgery where possible, along with the transfer of the superior oblique tendon to the superior part of the normal medial rectus muscle insertion area to create a tethering effect on a good outcome.

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