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After appropriate draping, a lid speculum was placed between the lids of the right eye. An incision was made supertemporally to expose the right medial rectus muscle. This was hooked with a muscle hook and secured with 6-0 Vicryl sutures and disinserted from the globe. It was reattached to the globe in hang-back, adjustable suture fashion, recessing it 6 mm from the original insertion. A 5-0 Mersilene suture was placed for traction purposes during the adjustment process.
The right superior rectus muscle was then approached through the same supranasal incision, hooked to the muscle hook and cleared of surrounding tissue far backwards over the top surface of the muscle, and was disinserted from the globe after being secured with a double-armed 6-0 Vicryl suture. It was reattached to the globe in hang-back adjustable suture fashion, recessing it 4 mm from the insertion site, and 5-0 mersilene traction suture was placed.
The left medial rectus muscle was then recessed in a similar manner, 5.5 mm on an adjustable suture. Both eyes were dressed with Pred-G ointment. The patient was returned to her room in good condition, having tolerated the procedure well.