Medial rectus damage occurs through inattention: if the orbital periosteum is traversed, the assistant should notice movement of the globe. The operator should be very cautious while operating on the lateral nasal wall in this area and ask the assistant to repeatedly ballotte the eye. Damage to the medial rectus normally occurs through deeper penetration into the orbit (Fig. 12.19). Unfortunately, even if it is recognized at the time, it is very difficult to prevent the scarring and diplopia that are likely to occur (Flynn et al., 1979). Even expert strabismus surgeons have difficulty in trying to improve the problems that are caused by damage to the medial rectus.
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