Erick D. Bothun, M.D., is a pediatric ophthalmologist and adult strabismus surgeon at Mayo Clinic in Rochester, Minnesota. One of Dr. Bothun's patients needed strabismus surgery to fix an exotropia alignment that caused the eyes to drift out. Watch as Dr. Bothun helps improve this patient's quality of life and the alignment of the patient's eyes through a bilateral lateral rectus exploration with re-recession and left medial rectus resection. Alright so mr. Business repair it is about restoring alignment but when they've had many surgeries before there's commonly scarring and abnormalities and muscle position from prior surgeries you can see he's had surgery somewhat recently and said multiple areas of thickening. Both latter directory have been operated on before. So commonly in a case like this you start with for destruction testing. You want to see if there's a range his eyes obviously pull out well he has a drift out extra trophy in the first place. And in my approach for lots of strabismus cases is to mark the cons first cut down and let's just go right across. That's why I'm gonna hook from above. Let's do half the muscle at a time. So we've cleaned off the lateral. You can see it nice fibers going posterior lee. I do a partial thickness pass. Alright so we have half the muscle isolated and now we're gonna go the other way. So you get a lock bite on each side. Some people put to lock bites. I just typically do one. So now we have the muscle on the sutures. So we've just taken the ladder off. Alright and then we can take that back out and then we'll pull the cons back forward. Eight oh vicryl. So we've done a lot of rectus recession on this fellow. I now we're turning to the right side, we're gonna go explore and do the same thing here. So muscles isolated. We know we're gonna recess it. So here's the partial thickness pass going in fairly And then at the Inferior pole of the latter rectus muscle will put a not so difficulty with exposure trying to get the lateral, but now the laterals off the I want to do for seduction testing. We're reattaching the muscle at a certain millimeter behind a certain distance behind where it started. In this case it's 14 mm behind the normal anatomical position. So we're way back on the eye. Now the eye lateral rectus muscle is reattached to the eye further back. But I do I do think we need more. So let's we're gonna let's just do a little quick resection of the media and then we're going to just dissect, spreading and trimming All right, So let's go ahead and implicate it to allow for receptions. The insertion is on the front hook. I'm stretching out the back hook, I mark across the back so you're going to pass your first partial thickness pass and then full thickness coming back for the lock bite. So here's the partial thickness. So the lower half is secure on an implicated bite of the muscle. And now we're going to do the super pole. Beautiful. So we're trimming the muscle off and then we'll kinda raise that stump the anti respected muscles right here. So we're going to lift that up with a forceps and take it off the eye. So let's reattach it here and here. So we have just respected this medial and further improving this gentleman's alignment. So he started out at the beginning of the case with ISA, drifted out. If anything right now there, they're closer a little bit in which is great.