Why pulley surgery in strabismus?

Abstract The recent innovations in the comprehension of orbital anatomy and extraocular muscles allow a better reflection about practical strabismus surgery. Trochlea anatomy for superior oblique muscle is well defined but Miller in 1987 in monkeys and Demer in 1994 first described functional pulleys for rectus extraocular muscles. These pulleys are based on connective tissue sleeves of collagen, elastin and smooth muscle that surround and stabilize the posterior extraocular muscles paths within the bony orbit. Imaging of the orbit is required to the understanding of variable effect on binocular alignment in strabismus. Different data can be obtained from the MRI as lateral rectus path lengths from orbital apex to first globe conta