Management of fixed divergent squint in third nerve palsy using traction sutures

Abstract

Background: Long-standing fixed divergent squint is a difficult management problem, presenting marked cosmetic and functional symptoms in the patient, and a significant challenge for the squint surgeon to overcome. Methods: We describe use of through-the-lid traction sutures in 24 consecutive patients with fixed divergent squint secondary to long-standing third nerve palsy. Very large recessions of the lateral rectus were combined with large resections of the medial rectus and traction sutures placed through the insertions of the superior and inferior rectus were brought out through the extreme medial fornices and skin of the upper and lower lids. Sutures were tied over tarsorrhaphy bolsters..