To compare the lower eyelid retraction following Lockwood’s ligament advancement versus retractor lysis associated with inferior rectus muscle recession.

In this prospective, nonrandomized, comparative case series, patients requiring inferior rectus recession of 4 mm or more for managing vertical strabismus underwent Lockwood’s ligament advancement versus lower eyelid retractor lysis. Lower eyelid margin reflex distances (MRD2) and vertical deviation were documented preoperatively and postoperatively.

There were 10 patients in the Lockwood advancement group and 12 patients in the retractor lysis group. No statistically significant difference was found in duration of follow-up, preoperative vertical deviation, amount of inferior rectus recession, residual deviation, and preoperative lid status between the two study groups (p>0.10 for all parameters). The average change of MRD2 was 0.70± 0.70 mm in the Lockwood advancement group, as compared with - 0.1± 0.43 mm in the retractor lysis group (P=0.004).

Retractor lysis is more efficient than Lockwood’s ligament advancement as a surgical modification to the inferior rectus recession to minimize postoperative lower lid retraction.