Strabismus surgery complicated by "pulled in two syndrome" in a case of breast carcinoma metastatic to the medial rectus muscle.

Metastatic carcinoma to the extraocular muscles is extremely rare; it is reported to occur from breast, lung, and gastric carcinoma as well as skin melanoma. (1-3) Overall, intraocular metastases occur much more frequently than orbital metastases.(4) The most common primary tumors causing orbital metastases are breast and lung carcinomas.(5) Strabismus due to orbital metastases from breast carcinoma usually results from fibrosis of the muscle, which often causes painful ophthalmoplegia and enophthalmos. (6,7) We report a case of presumed metastatic carcinoma to the medial rectus muscle causing restrictive strabismus in which surgery was complicated by the "pulled in two syndrome," or PITS.