A modified technique for attaching the lateral rectus muscle to the orbital periosteum through a skin incision over the lateral orbital rim

Abstract

The traditional approach for periosteal fixation of the lateral rectus muscle involves securing the muscle using nonabsorbable sutures by exposing the orbital periosteum 5mm to the inside of the orbital margin. We present a simplified approach that exposes the orbital periosteum through a skin incision, providing more room and avoiding extraconal fat manipulation. We used our technique to expose the lateral orbital periosteum and suture the lateral rectus muscle to the periosteum using nonabsorbable sutures in 2 patients with exotropic Duane retraction syndrome and 1 patient with congenital oculomotor nerve palsy. All 3 patients had satisfactory postoperative alignment, with abduction limitation of 3-. Adduction improved in all patients. The patient with oculomotor nerve palsy had a small overcorrection in primary position that remained stable during follow-up of 18months. There were no intraoperative complications. This modified approach to extraocular muscle periosteal fixation may be simpler thanthestandard approach. Further evaluation in a larger series of patients is warranted.