To report a case of double-layered conjunctival autograft and amniotic membrane transplantation for the effective treatment of esotropia and hypotropia after removal of the recurrent pterygium.

A 58-year-old male who had pterygium surgery of the right eye twice presented with diplopia on right gaze for 3 months. At the first visit, he had orthotropia in the primary position and right esotropia of 12 prism diopters (PD) on right gaze with limited abduction of -1 in the right eye. Fourteen months later, deviation was aggravated by esotropia of 30 PD and 12 PD of right hypotropia in the primary position at distance, and esotropia of 35 PD and 12 PD of right hypotropia at near with limited abduction of -2 and supraduction of -3 in the right eye. The patient complained of diplopia at all gazes and demonstrated chin-up posture. The conjunctival edge was recessed near the medial canthus and fornix, preventing conjunctival autograft after removal of subconjunctival scar tissue. Thus, 5 mm right medial rectus recession and additional half-sized conjunctival autograft were performed after amniotic membrane transplantation. The patient than showed no diplopia and orthotropia at both distance and near, with limited adduction of -1 in the right eye. He experienced no recurrence during 7 months of follow-up.

To prevent poor epithelial regeneration and dehiscence of graft in the patients with severe restrictive strabismus and very extensive conjunctival defect, double-layered conjunctival autograft and amniotic membrane transplantation may be effective for the treatment of severe esotropia and hypotropia.