Recognition and repair of the slipped rectus muscle

Since the first description of the slipped muscle as a complication of strabismus surgery in 1979, the distinctions between it and the lost muscle have become blurred both in the literature and in general understanding. Sixtytwo slipped muscles in 52 consecutive patients were reviewed in an effort to more fully describe this Important and often unrecognized entity. The range of clinical presentation of slipped muscle is large: from the immediate large postoperative over- or undercorrection with absent duction, to the gradual moderate deviation with subtly reduced excursion. The auctions provided by the slipped muscles ranged from complete absence to almost normal, with an average of 19° excursion beyond the midline. At surgery, recognizing the empty muscle capsule attached to the sclera with the tendon slipped posteriorly within it is imperative for its repair. Recognition is facilitated by suspecting it from clinical findings. Correction of the motility defect requires advancement of the muscle tissue and not just its empty capsule. Slippage can probably be prevented by using a surgical technique, which firmly locks the suture to the tendon and not just to the muscle capsule.