FIG 1.

Using blue dots at the limbus to monitor intraoperative torsion during augmented vertical muscle transposition. A, Marking 12 o’clock and 6 o’clock at each limbus at the start of the case, following induction of anesthetic, using a sterile skin marking pen. B, Intorsion of left eye (surgeon’s view) after both superior rectus muscle and inferior rectus muscle have been transposed laterally and after tying only the superior augmentation suture. C, Inferior augmentation suture is bow tied, setting the inferior rectus muscle belly approximately 3 mm from the lateral rectus (LR) muscle belly (arrow in C). D, Eye is then noted to be still slightly intorted. E, The inferior augmentation suture is untied and the inferior rectus (IR) muscle belly pulled up 1 mm more until there is no residual torsion. F, The inferior augmentation suture is then permanently tied, leaving the inferior rectus muscle belly, in this case, 2 mm from the lateral rectus muscle belly (arrow).