Shivanand Sheth1, Susan Carden1,2

Purpose: To describe a technique of performing horizontal extraocular rectus muscle recessions with minimum disruption of Tenon’s capsule around the muscle.

Method: Conjunctival opening is made via limbal or fornix approach. Horizontal rectus muscle to be recessed is hooked. Tenons’ capsule around the muscle is carefully dissected off from the conjunctival and scleral surface of the extraocular muscle, but without stripping it off from the muscle itself. A small 1 – 2 mm opening in Tenon’s capsule is made only at the muscle insertion to visualize muscle fibres and secure them with locking Vicryl sutures. Muscle is disinserted, desired amount of recession is completed and conjunctiva is closed.

Results: Horizontal rectus muscle recessions can be successfully done without extensive dissection of Tenon’s capsule off the muscle, especially if Tenon’s capsule is freed from overlying conjunctiva and underlying sclera.

Conclusion: Tenon’s capsule is a physiological protective layer around extraocular muscles and it may be unnecessary to strip Tenon’s capsule over a large portion off the extraocular muscle for recessions.