Medial rectus muscle entrapment, right eye

This code signifies a condition where the medial rectus muscle of the right eye is physically trapped or restricted, often due to trauma, orbital fracture, or surgical complications. This entrapment limits the eye's ability to move laterally (abduction), leading to diplopia and restricted gaze.

Apply this code when documentation clearly indicates entrapment of the right medial rectus muscle, typically identified through imaging (e.g., CT scan) and clinical examination demonstrating restricted abduction of the right eye. This code is appropriate for cases of mechanical restriction, not just paresis or paralysis.

• Differentiate from muscle paresis or paralysis; this code specifically indicates mechanical entrapment.
• Ensure laterality is accurately documented (right eye).
• Consider sequencing with codes for underlying causes, such as orbital fractures (S02.1xx) or other orbital trauma.