Strabismus pp 131-146 | Cite as

Horizontal Muscle Strabismus Surgery

  • Siddharth Agrawal
  • Priyanka Singh
  • Rajat M. Srivastava


Surgical success is determined by precision in execution of the surgical process, which in turn depends on clear understanding of the technique. This chapter will highlight the instrumentation, anesthesia, and surgical techniques of horizontal muscle strabismus surgery.


Strabismus surgery Instrumentation Recession Resection Hang-back recession Adjustable suture Oculocardiac reflex 


  1. 1.
    Modarres M, Parvaresh MM, Hashemi M, Peyman GA. Inadvertent globe perforation during retrobulbar injection in high myopes. Int Ophthalmol. 1997;21:179–85.CrossRefGoogle Scholar
  2. 2.
    Duker JS, Belmont JB, Benson WE, Brooks HL Jr, Brown GC, Federman JL, Fischer DH, Tasman WS. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome. Ophthalmology. 1991;98(4):519–26.CrossRefGoogle Scholar
  3. 3.
    Tejedor J, Ogallar C, Rodríguez JM. Surgery for esotropia under topical anesthesia. Ophthalmology. 2010;117(10):1883–8.CrossRefGoogle Scholar
  4. 4.
    Dahlmann-Noor AH, Cosgrave E, Lowe S, Bailly M, Vivian AJ. Brimonidine and apraclonidine as vasoconstrictors in adjustable strabismus surgery. J AAPOS. 2009;13(2):123–6.CrossRefGoogle Scholar
  5. 5.
    Mojon DS. Comparison of a new, minimally invasive strabismus surgery technique with the usual limbal approach for rectus muscle recession and plication. Br J Ophthalmol. 2007;91(1):76–82.CrossRefGoogle Scholar
  6. 6.
    von Noorden GK, Campos EC. Principles of surgical treatment. In: von Noorden GK, Campos EC, editors. Binocular vision and ocular motility. 6th ed. St. Louis: Mosby; 2002. p. 566–631.Google Scholar
  7. 7.
    Agrawal S, Singh V, Gupta SK, Agrawal S. Comparison between limbal (von Noorden) and para limbal (Santiago) conjunctival incisions for adjustable recessions of horizontal recti. Nepal J Ophthalmol. 2013;5(2):220–5.PubMedGoogle Scholar
  8. 8.
    von Noorden GK. Modification of the limbal approach to surgery of the rectus muscles. Arch Ophthalmol. 1969;82:349–50.CrossRefGoogle Scholar
  9. 9.
    Santiago AP, Isenberg SJ, Neumann D. The paralimbal approach with deferred conjunctival closure for adjustable strabismus surgery. Ophthalmic Surg Lasers. 1998;29:151–6.PubMedGoogle Scholar
  10. 10.
    Swan KC, Talbot T. Recession under Tenon’s capsule. Arch Ophthalmol. 1954;51:32–45.CrossRefGoogle Scholar
  11. 11.
    Parks MM. Fornix incision for horizontal rectus muscle surgery. Am J Ophthalmol. 1968;65(6):907–15.CrossRefGoogle Scholar
  12. 12.
    Clark RA, Rosenbaum AL. Instrument induced measurement errors during strabismus surgery. J AAPOS. 1999;3(1):18–25.CrossRefGoogle Scholar
  13. 13.
    Agrawal S, Singh V, Yadav A, Bangwal S, Katiyar V. Modified adjustable suture hang-back recession: description of technique and comparison with conventional adjustable hang-back recession. Indian J Ophthalmol. 2017;65:1183–6.CrossRefGoogle Scholar
  14. 14.
    Lueder GT, Scott WE, Kutschke PJ, Keech RV. Long-term results of adjustable suture surgery for strabismus secondary to thyroid ophthalmopathy. Ophthalmology. 1992;99:993–7.CrossRefGoogle Scholar
  15. 15.
    Park YC, Chun BY, Kwon JY. Comparison of the stability of postoperative alignment in sensory exotropia: adjustable versus non-adjustable surgery. Korean J Ophthalmol. 2009;23:277–80.CrossRefGoogle Scholar
  16. 16.
    Bishop F, Doran RM. Adjustable and non-adjustable strabismus surgery: a retrospective case-matched study. Strabismus. 2004;12:3–11.CrossRefGoogle Scholar
  17. 17.
    Agrawal S, Singh V, Singh P. Adjustable recessions in horizontal comitant strabismus: a pilot study. Indian J Ophthalmol. 2015;63:611–3.CrossRefGoogle Scholar
  18. 18.
    Tripathi A, Haslett R, Marsh IB. Strabismus surgery: adjustable sutures—good for all? Eye. 2003;17:739–42.CrossRefGoogle Scholar
  19. 19.
    Flynn JT. The adjustable suture: a clinician's experience. Pediatric ophthalmology and strabismus: transactions of the New Orleans Academy of Ophthalmology. New York: Raven Press; 1986. p. 245–6.Google Scholar
  20. 20.
    Keech VR. Adjustable suture strabismus surgery. In: Duane TD, Jaeger EA, editors. Duane’s clinical ophthalmology, vol. 6. Philadelphia, PA: Lippincott Williams and Wilkins; 2009.Google Scholar
  21. 21.
    Bleik JH, Karam VY. Comparison of the immediate with the 24-hour postoperative prism and cover measurements in adjustable muscle surgery: is immediate postoperative adjustment reliable? J AAPOS. 2004;8(6):528–33.CrossRefGoogle Scholar
  22. 22.
    Velez FG, Chan TK, Vives T, Chou T, Clark RA, Keyes M, et al. Timing of postoperative adjustment in adjustable suture strabismus surgery. J AAPOS. 2001;5(3):178–83.CrossRefGoogle Scholar
  23. 23.
    Morris RJ, Luff AJ. Adjustable sutures in squint surgery. Br J Ophthalmol. 1992;76:560–2.CrossRefGoogle Scholar
  24. 24.
    MacEwan CJ, Lee JP, Fells P. Aetiology and management of the ‘detached’ rectus muscle. Br J Ophthalmol. 1992;76:131–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Siddharth Agrawal
    • 1
  • Priyanka Singh
    • 2
  • Rajat M. Srivastava
    • 1
  1. 1.Department of OphthalmologyKing George’s Medical UniversityLucknowIndia
  2. 2.Aravind Eye HospitalMaduraiIndia

Personalised recommendations