Extraocular Muscle Fixation to the Orbital Wall

The surgical results of severe or complex deviations such as those due to completethird nerve palsy, aberrant innervation of extraocular muscles (eoms) and duanesyndrome are usually not completely successful. herein, we describe the surgicaltechnique of eom fixation to the orbital wall. after a limbal or fornix based conjunctivalincision, the related eom is identified and dissected; the muscle insertion is suturedwith non-absorbable sutures and detached from the sclera. the adjacent periosteum isexposed approximately 5 mm posterior to the orbital rim. the sutured muscle is thenfixed to the orbital wall with two periosteal bites. the cut edges of the intermuscularmembrane 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 ofeom inactivation completely eliminates all muscle forces from the globe and canprovide better alignment in the above mentioned types of strabismus. the procedureis reversible and can be converted to other types of weakening operations if necessary.