Dehiscence of a muscle during surgery has been termed pulled-in-two syndrome (PITS). The dehiscence usually occurs at the tendon–muscle junction, and the inferior rectus may be the most frequently affected muscle. Advanced age, various myopathies, previous surgery, trauma, or infiltrative disease may predispose a muscle to PITS by weakening its structural integrity. Treatment is recovery, when possible, using techniques similar to those used for lost muscles, and re-anastomosis of the muscle.
Figure 14-1 Slipped left medial rectus muscle. Left, Gaze right shows inability to adduct the left eye. Center, Exotropia in primary position. Right, Gaze left shows full abduction. Note that the left palpebral fissure is wider than the right, especially with attempted adduction.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.