fat adherence syndrome
Definition A popular term for progressive and permanent restrictive strabismus attributed to the intrusion of extraconal orbital fat in the sub-Tenon space or episcleral space, which may follow periocular surgery–e.g., strabismus surgery, scleral buckling surgery, surgery on the inferior oblique muscle–IOM (affecting ±2% of patients undergoing IOM surgery), or trauma.
Pathogenesis The fat comes in contact with the extraocular muscles, the sclera and orbial connective tissue, and develops a fibrous scar attached to the orbital periosteum, which constricts with time, resulting in restrictive strabismus and limitation of ocular movement.
Clinical findings Progressive hypotropia, inability to fully raise the eye, positive forced duction testing
References J AAPOS. 2004 Aug;8(4):349-56