Lateral orbitotomy in the management of challenging exotropia.

The authors present an unorthodox surgical approach to reach the posterior segment of the lateral rectus muscle through a lateral orbitotomy and to manage difficult cases of recurrent exotropia. A review of the records of two patients with recurrent exotropia was done. After an anterior approach had been demonstrated to be inadequate due to shortening or fibrosis of the anterior part of this muscle following repeated surgeries, both patients underwent a lateral orbitotomy to reach the posterior segment of the lateral rectus muscle. Both patients achieved satisfactory ocular alignment following surgery with stable results, showing that this approach is a safe and effective surgical procedure.