Bilateral inferior oblique muscle paresis after posterior subtenon injection of triamcinolone acetonide

Posterior subtenon injections of steroidal drugs are commonly used to treat various chorioretinal inflammatory diseases. Subsequent strabismus is rare, but it is associated with severe visual disturbance when present. We report a case of simultaneous bilateral inferior oblique muscle paresis in a 60-year-old man who developed it after receiving intravitreal injections of bevacizumab and posterior subtenon injections of triamcinolone acetonide for the treatment of diabetic macular edema. The patient complained of excessive pain during the injections, which were performed at the 6 o'clock position in both eyes. According to the literature, inferior oblique muscle paresis after posterior subtenon injections is rare. This complication may be prevented by proper selection of the injection site and paying attention to any unusual patient complaints during the procedure.