A 50-year-old man with a long-standing, large-angle exotropia and limitation of adduction in the left eye

A 50-year-old man was referred for management of a long-standing, large-angle exotropia and limitation of adduction in the left eye. He had a history of poor vision in the left eye since childhood and 4 previous strabismus procedures. The most recent strabismus surgery was 38 years before presentation. Prior records were unavailable, and the patient could not recall any details pertaining to his earlier procedures or alignment in childhood. His wife did not report any recent change in his appearance or alignment.