Lateral rectus muscle disinsertion and reattachment to the lateral orbital wall

• Published in: British journal of ophthalmology Vol. 89; no. 8; pp. 983 - 985
• Main Authors: Morad, Y, Kowal, L, Scott, A B
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.08.2005; BMJ; BMJ Publishing Group LTD; Copyright 2005 British Journal of Ophthalmology
• Subjects: Adolescent; Biological and medical sciences; Child, Preschool; Clinical Science - Scientific Reports; Duane Retraction Syndrome - surgery; Duane syndrome; Eye Movements; Female; Head injuries; Humans; inferior rectus; lateral rectus muscle disinsertion; magnetic resonance imaging; Male; Medical sciences; Middle Aged; Miscellaneous; Motility; MRI; NMR; Nuclear magnetic resonance; Oculomotor Muscles - surgery; Oculomotor Nerve Diseases - surgery; Ophthalmology; Orbit - surgery; orbital wall; Paralysis; Recessions; superior rectus; Surgery; Treatment Outcome; Orbit(eye); Muscle; Ophthalmology
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2004.051219

Background/aims: Surgical correction of ocular alignment in patients with third cranial nerve paralysis is challenging, as the unopposed lateral rectus muscle often pulls the eye back to exotropia following surgery. The authors present a simple surgical approach to overcome this difficulty. This approach is also applicable to removal of unwanted overactivity of the lateral rectus in Duane syndrome. Methods: A review was made of the records of four patients with third cranial nerve paralysis and one with Duane syndrome with exotropia in which the lateral rectus muscle was removed from its scleral insertion and reattached to the orbital wall. Additional surgery to bring the eye to the midline included medial rectus resection, medial transposition of the vertical recti, and passive suturing of the eye to the medial orbit wall. Results: All patients achieved satisfactory ocular alignment following surgery. Ocular ductions were limited. These results were stable for 1.5–4 years of follow up. No major complications occurred. Conclusion: Lateral rectus muscle disinsertion and reattachment to the orbital wall to absorb its force and thus remove abduction torque was a simple and safe surgical procedure for restoring ocular alignment in four patients with third cranial nerve paralysis and in one patient with Duane syndrome with severe exotropia.