Anterior segment ischemia (ASI) can occur following strabismus surgery on multiple muscles. Procedures such as modified Nishida procedure (MNP) have been developed to reduce the risk of ASI. We report the case of a 68-year-old patient presenting with traumatic bilateral abducens nerve palsies who required surgical intervention. We performed MNP with medial rectus recession. The patient presented with reduced vision, corneal edema, anterior chamber reaction, and pupillary dilation 24 hours after surgery. A diagnosis of ASI was made, and immediate reversal of the Nishida procedure was performed. Symptoms improved within 24 hours. In this case, ASI may have been caused by ligation and compression of ciliary arteries due to overstretching of the vertical rectus muscles during transposition.
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