Complicated strabismus and adjustable sutures

Clinical experience in performing over 500 adjustable strabismus operations is mentioned in this paper particularly as it relates to complicated strabismus. A maximum hang-loose recession of a rectus muscle has a limited effect, which is tabulated and the implications discussed. Aids in finding the lost medial rectus muscle are mentioned. Adjustable sutures are then exploited in managing the found "lost" medial rectus. Adjustable recession of both vertical recti in the affected eye were used in some cases of blow-out fracture to manage limitations of upward and downward gaze. Adjustable recession of both yoke medial recti are used in some unilateral superior oblique palsies where the main sequela is hypertropia in downward gaze only. A previously paralysed lateral rectus muscle, which has completely recovered function but has left the patient with a concomitant esotropia with full ductions and normal versions, responds excessively to resection. This should be taken into consideration when planning adjustable strabismus surgery in such a case.