MANAGEMENT OF FIXED DIVERGENT SQUINT IN 3RD NERVE PALSY USING TRACTION SUTURES

Background: Long-standing fixed divergent squint is a difficult manage ment problem, presenting marked cosmetic and functional symptoms in th e patient, and a significant challenge for the squint surgeon to overc ome. Methods: We describe use of through-the-lid traction sutures in 2 4 consecutive patients with fixed divergent squint secondary to long-s tanding 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 re ctus were brought out through the extreme medial fornices and skin of the upper and lower lids. Sutures were tied over tarsorrhaphy bolsters and left in situ for six weeks. Results: After removal of the tractio n sutures, the eye maintained a good cosmetic position in all but two cases. Postoperative motility was extremely limited or absent. Complic ations were limited to transient skin ulceration in two cases. Conclus ions: Supramaximal horizontal recess-resect procedure combined with ad ducting traction sutures left in situ for six weeks is a safe and effe ctive procedure to restore the eye to the centre of the palpebral fiss ure.