Fornix incision for horizontal rectus muscle surgery.

The conventional exposure of a horizontal rectus muscle is through conjunctival and Tenon's capsule incisions directly over the muscle. This results in a visible scar and in some patients is conspicuously unattractive. Therefore, a surgical method that hides the scar behind the eyelid should be welcomed by both the surgeon and patient. To accomplish this objective the medial and lateral rectus muscles are exposed through conjunctival and Tenon's capsule incisions in either the inferior or superior fornix. The goal should be not only to hide the scar in the fornix, but to minimize it. Every consideration should be given to handling the tissues delicately and every opportunity utilized to adopt the available improved smallcaliber sutures, needles, and instruments into one's technique. A recession and a resection of the medial rectus muscle through the fornix incision, incorporating a technique designed to mini­ mizing the scarring, are illustrated in detail and discussed. Routinely, the inferior fornix incision is used rather than the superior for­ nix, unless, in reattaching the tendon to the sclera, supraplacement is indicated for the treatment of an A or V deviation. In fact, supraplacement of a medial or lateral rectus muscle is almost impossible to accomplish through the inferior fornix incision. The il­ lustrations depict surgery through only the inferior fornix incision. The six plates so well illustrate and de­ scribe each step in the surgery that redun­ dancy is avoided by not describing each step in detail in the text. However, important points about the technique that cannot be il­ lustrated are discussed as they apply to each plate.