Ellis et al reported data on patients with the Pulled in Two Syndrome (PITS) following strabismus surgery.
The Pulled in Two Syndrome refers to rupture of an extraocular muscle typically during or after strabismus surgery.
Patterns:
(1) snipped: inadvertent cutting of the muscle or sutures securing the muscle
(2) snapped: rupture of the muscle during operative manipulation, sometimes with a surgical muscle hook
(3) slipped: detachment in early postoperative period with retraction into the capsule
Risk factors for PITS (some associated with muscle degeneration)
(1) cranial nerve palsy
(2) prior surgery on the extraocular muscles
(3) older age (>= 50 years of age)
(4) thyroid disease
(5) scleral buckle
(6) ocular or orbital trauma
(7) mitochondrial myopathy
(8) congenital fibrosis of the muscles
(9) Down's syndrome
(10) myasthenia gravis
(11) congenital exotropia
(12) strabismus fixus
(13) radiation
(14) botulinum toxin A injection
(15) congenital rubella
Possible risk factors not mentioned:
(1) severe malnutrition
(2) corticosteroid therapy
