Surgery: Inferior Oblique Myectomy

This video shows an unedited left inferior oblique myectomy procedure, with an incision made between the inferior and lateral recti. The inferior oblique muscles are exposed using small hooks, with attention given to the vortex veins to avoid injury. The muscle is prepared for myectomy using clamps, and continuous white muscle capsule is observed with no missed posterior fibers. The stumps are cauterized, leading to spontaneous retraction inside the orbit, and the procedure concludes with inspection for bleeding or fat prolapse and closure of the conjunctival fornix incision.

Surgeon: Jamal Bleik, MD
Associate Dean for Clinical Affairs , Clinical Professor and Chairman
Department of Ophthalmology, Lebanese American University, Beirut, Lebanon


This is an unedited video of a left inferior oblique myectomy using the surgical microscope. The conjunctiva is incised between the inferior and lateral recti, which can be easily identified by their anterior ciliary arteries.

A small snip is done in the subconjunctival tissue. The lateral rectus is hooked using two small hooks, and then a large hook is passed under the lateral rectus.

The globe is rotated towards the surgeon and the retractor is used to expose the inferior oblique muscles.

Two small hooks are used to expose the inferior oblique, paying attention to the vertex vein and avoiding its injury.

The inferior oblique is brought out of its bed and the small snip is done in the posterior tenon.

The inferior oblique muscle is pulled using two muscle hooks outwards and stretched and two clamps are used to prepare the muscle for the myectoid.

The continuous white muscle capsule is seen under the microscope as an indication that no posterior fibers of the inferior oblique were missed.

The stumps are cauterized and then released, and they can be seen to retract spontaneously inside the orbit.

The wound is then inspected to make sure that there is no bleeding or fat prolapse.

And the forced action test for the inferior oblique is performed to ensure that a complete myectomy was achieved.

The conjunctival fornix incision usually is self co opted or one 8-0 vicryl suture can be used to close it.

Last Updated: April 23, 2024

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