Background and purpose: The loss of an extraocular muscle is an infrequent but serious complication of strabismus surgery. The purpose is to show that a tailored tongue of Tenon's capsule, 7.0 mm to 9.0 mm wide and 12.0 mm to 14.0 mm long, fashioned in the direction of a lost medial rectus muscle and attached at the site of its original insertion can restore full ocular movement in the direction of action of the muscle.
Case report: Thisis a report of a patient who underwent re-shaping and attachment of Tenon's capsule to the original insertion of the medial rectus muscle that ruptured during attempted medial rectus recession for longstanding esotropia with medial rectus restriction. The procedure was done immediately following the loss and failure to retrieve the lost muscle.
Results: Residual large angle esotropia and good adduction were obtained postoperatively despite a severed and consecutively lost medial rectus muscle.
Conclusion: A tongue of Tenon's capsule, attached at the original site of a lost extraocular rectus muscle in a young adult, works as a pseudo-tendon successfully restoring function in the direction of action of that muscle.