In this presentation from Pediatric Ophthalmology Subspecialty Day 2022, Dr. Sylvia Kodsi explains why you should advance the medial rectus (MR) muscles in a patient with consecutive exotropia after bilateral MR recession. She discusses the following, among other topics:

• why patients develop consecutive exotropia after good initial alignment
• types of abnormal scleral attachment: slipped muscle and stretched scar
• the Donahue paper on MR advancement for secondary exotropia