Extraocular Muscle Fixation to the Orbital Wall

The surgical results of severe or complex deviations such as those due to complete third nerve palsy, aberrant innervation of extraocular muscles (EOMs) and Duane syndrome are usually not completely successful. Herein, we describe the surgical technique of EOM fixation to the orbital wall. After a limbal or fornix based conjunctival incision, the related EOM is identified and dissected; the muscle insertion is sutured with non-absorbable sutures and detached from the sclera. The adjacent periosteum is exposed approximately 5 mm posterior to the orbital rim. The sutured muscle is then fixed to the orbital wall with two periosteal bites. The cut edges of the intermuscular membrane are closed over the sclera to avoid adherence of the muscle to the sclera. Finally the conjunctiva is reapproximated or recessed if necessary. This method of EOM inactivation completely eliminates all muscle forces from the globe and can provide better alignment in the above mentioned types of strabismus. The procedure is reversible and can be converted to other types of weakening operations if necessary.