_______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 2019 Jun 15; 7(11):1825-1827. 1825 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2019 Jun 15; 7(11):1825-1827. https://doi.org/10.3889/oamjms.2019.487 eISSN: 1857-9655 Case Report Incomitant Exotropia After Nasal Polyp Surgery Ni Made Ayu Surasmiati * , Ni Made Wasiastiti Budi, AAA Sukartini Djelantik, Ni Made Laksmi Utari, Putu Yuliawati, Ni Made Ari Suryathi Ophtalmology Department, Udayana University, Faculty of Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia Citation: Surasmiati NMA, Budi NMW, Djelantik AAA S, Utari NML, Yuliawati P, Suryathi NMA. Incomitant Exotropia after Nasal Polyp Surgery. Open Access Maced J Med Sci. 2019 Jun 15; 7(11):1825-1827. https://doi.org/10.3889/oamjms.2019.487 Keywords: Incomitant; Exotropia; Nasal Polyp *Correspondence: Ni Made Ayu Surasmiati. Ophthalmology Department, Udayana University Faculty of Medicine Sanglah Hospital, Denpasar, Bali - Indonesia. E-mail: agrasidi01@gmail.com Received: 21-Apr-2019; Revised: 25-May-2019; Accepted: 26-May-2019; Online first: 14-Jun-2019 Copyright: © 2019 Ni Made Ayu Surasmiati, Ni Made Wasiastiti Budi, AAA Sukartini Djelantik, Ni Made Laksmi Utari, Putu Yuliawati, Ni Made Ari Suryathi. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist Abstract BACKGROUND: Incomitant exotropia is one of ocular complication that has been reported after intranasal surgery. This case report aims to describe the causes of exotropia in a patient with a history of nasal polyp surgery. CASE PRESENTATION: A 50-years-old male, came with the main complaint of double vision 1 month after nasal polyp surgery. He also complained his right eye turned outward. The visual acuity on the right eye was 6/7.5 with his head turn to the left. On the examination, the Hirschberg test was XT 45°, and the Krimsky test > 95 ∆BI. Duction and version test on the right eye were -4 adduction. There was no shifting on the cover-uncover test. Ishihara test was within normal limit, and there was suppression on the right eye in WFDT. On force generation test, we found limited adduction on the right eye and no restriction in force duction test. Head MRI showed atrophy of medial recti on the right eye, 2.2 mm in size. The patient underwent vertical muscle transposition procedure surgery, and it was found atrophy of medial recti without any rupture. Two months after surgery, the double vision was decreased, the result of the Hirschberg test was XT 30° and Krimsky test 65°∆BI. DISCUSSION: Nasal polyp surgery-related incomitant exotropia mostly caused by extraocular muscles rupture. In this case, we found no rupture. Therefore, we suspected the abnormalities of muscles vascularisation, supported by the atrophy of medial recti. Introduction A nasal polyp is a chronic inflammatory process in the nasal mucosa, or paranasal sinuses which characterised by edematous mass with infection is the most important factor in this process. Prevalence of polyp nasal in Indonesian was up to 4.63% of all register patient at Dr Soetomo Surabaya Hospital. In the last ten years, sinus surgery techniques that commonly used is Endoscopic, which is commonly used for intranasal ethmoidectomy. Besides the advantage, endoscopic had a risk to damage the extraocular muscle, especially at ethmoidal sinuses. The estimated rate of ocular injury after intranasal sinus surgery is up to 3%. The most common ocular complications after paranasal and intranasal polyps' surgery such as extraocular muscle rupture and extraocular muscle paralysis, vascular disorders or extraocular muscle innervation, microvascular infarction, chronic infection or inflammation, tumour mass compression. Incomitant exotropia is one of ocular complication that had been reported after intranasal surgery [1], [2]. Incomitant exotropia is a form of strabismus which is outward deviation of the eyes with different angles of deviation in different motion field. The most common caused is due to paralysis or restriction [3], [4]. This case report aims to describe the causes of exotropia in a patient with a history of nasal polyp surgery. Case Presentation A 50-years old, male patient whose initial presentation was a double vision in the past one month after nasal polyp surgery, and it had been getting worse. The right eye turned outward with minimal blurry vision. History of trauma and neurological disorder was denied.