Conjunctival retraction suture for fornix adjustable strabismus surgery.

The fornix approach to strabismus surgery is advantageous because the incision is made under the eyelid, there is no need for conjunctival sutures, it is comfortable for the patient, and there is minimal postoperative scarring. The major disadvantage of the fornix approach for the adjustable suture technique has been poor exposure to the muscle-suture apparatus and poor postoperative knot exposure. We describe herein the use of a subconjunctival retraction suture for adjustable suture surgery with the fornix approach. This suture retracts the conjunctiva, exposing the adjustable muscle-suture apparatus while simultaneously fixating the globe. A novel way of tying the noose around the pole sutures and preventing noose slippage is also presented. This technique provides excellent exposure, fixation of the globe, and complete coverage of the knot with conjunctiva after adjustment.