Among the formidable ocular problems to yield to surgical attack in the past decade are those severe malpositions of the eye from paralyses of the extraocular muscles of known causes, such as orbital fractures or thyroid disease, and from those of unknown etiology, such as idiopathic oculomotor paralysis. Of course, surgical repair is not indicated for all patients so affected and is contraindicated for some. However, for those patients who can be helped by operation, it is essential that the sclera be covered adequately by conjunctiva. This should be provided by mucosal grafts or by rearrangement of the conjunctiva that is present, so that the new, improved anatomicophysiological relationships created by recessions, advancements, and resections of the extraocular muscles will not be deterred or retarded by reuniting inadequate conjunctiva which would return the eye to its original malposition.
The surgical failure that has often followed an attempt to correct the
CALLAHAN A. The Arrangement of the Conjunctiva in Surgery for Oculomotor Paralysis and Strabismus. Arch Ophthalmol. 1961;66(2):241–246. doi:10.1001/archopht.1961.00960010243016