Navigating the challenge: Successful management of inferior rectus hypoplasia and supernumerary lateral rectus

Congenital isolated absence and hypoplasia of extraocular muscles is a rare condition that is frequently linked to craniofacial syndromes. The superior oblique muscle is most commonly noted to be absent, followed by the inferior rectus (IR) muscle. This is a case of a 20-year-old woman, diagnosed with left eye IR hypoplasia. The management of IR hypoplasia typically involves multiple rectus muscle operations, such as the transposition of horizontal recti muscles or the recession of the superior rectus muscle. However, these procedures carry the risk of anterior segment ischemia. In this case, the surgical strategy employed consisted of resection and downward shifting of the lateral rectus alongside anterior transposition of the inferior oblique yielded positive outcomes in terms of alignment and elevation, while minimizing the risk of anterior segment ischemia.