Pulled-in-two syndrome: a multicenter survey of risk factors, management and outcomes

Our data suggests that strabismus surgeons might encounter one case of PITS approximately every 10 years. Major risk factors for PITS appear to be changes in the extraocular muscle due to cranial nerve palsy, prior surgery, and advancing age. The preferred management for PITS is surgical recovery and reattachment of the muscle; however, if the muscle is lost, transposition surgery or observation are common forms of management.