Anterior segment ischemia syndrome following rectus muscle transposition

Two patients developed clinically significant anterior segment ischemia following full tendon transposition of the superior and inferior recti muscles nine and 20 years after they underwent horizontal rectus muscle surgery. Ipsilateral carotid artery ligation in one patient and possible hyperlipoproteinemia type II in the other were discovered postoperatively and may have contributed to the circulatory disturbances observed. In adult patients with paretic strabismus, the most important function of the paretic muscle may be maintenance of circulation to the anterior segment of the eye.