We also found out that patient selection is very important and therefore, a detailed preoperative assessment of ptosis especially to rule out associated superior rectus
weakness, poor Bells phenomenon and other associated systemic and ocular disorders must be carried out in every patient.
Muscle width and thickness were measured for individual muscles (inferior rectus, medial rectus, lateral rectus, superior rectus
and superior obliquus).
They innervate superior rectus
, inferior rectus, medial rectus and inferior oblique muscle, and levator palpebrae muscle.
Ten months after the initial surgery, he underwent a full-thickness transposition of the superior and inferior rectus muscles to the lateral rectus muscle and a 5/0 multifilament nonabsorbable lateral fixation suture (Foster) was placed in the sclera 8 mm posterior to the lateral rectus insertion incorporating the superior rectus
and one fourth of the lateral rectus muscle.
This occurs in order of frequency in the inferior rectus, medial rectus, superior rectus
, lateral rectus, oblique muscles, although most commonly all muscles are involved.
Although there were single, multiple, and bilateral affections of the extraocular muscles in this group, non-involvement of the inferior and superior rectus
muscles is noticeable.
Table 1: Extraocular examination of left eye Extraocular muscle Function Movement of left eye Medial rectus Adduction Absent Superior rectus
Elevator in abduction Absent Inferior rectus Depressor in abduction Absent Inferior oblique Elevator in adduction Absent Superior oblique Depressor in adduction Present but not full Lateral rectus Abduction Absent
2 cm in the right orbit along the right lateral rectus and superior rectus
In cases of secondary IR restriction, the hypotropia will persist after IRR because of primary superior rectus
muscle (SR) palsy.
5 Traction upon the superior rectus
suture also leads to a considerable rise in IOP and this should be avoided unless strictly necessary.
innervates the respective contralateral superior rectus
Undercorrection with hypotropia resulted in one eye of a patient having severe ptosis with 4 mm of levator function, probably due to pull on superior rectus
while doing maximum levator resection.