Pulled-in-two syndrome in a young woman with restrictive strabismus and rare genetic mutation

Pulled-in-two syndrome (PITS) is a rare but serious complication of strabismus surgery, with a reported incidence of once every decade among strabismus surgeons. It occurs more commonly in patients of advanced age and those with cranial nerve palsies or who have undergone prior surgeries. We present a case of PITS in a young female, diagnosed following surgery with a hereditary myosin myopathy.