Dr. Ken Wright performs a left medial rectus plication in a patient with sensory exotropia, previous trauma, and previous penetrating keratoplasty (PK). Compared with resection, plication has the advantage of sparing the anterior ciliary vessels, reducing the chance of postoperative anterior ischemia. Posterior dissection of the intermuscular septum is completed for a 5-mm plication. Dr. Wright uses a grooved hook to pass multiple locking bites through the center of the muscle. Intrasceral sutures are then passed through the posterior and inferior poles of the medial rectus muscle, parallel to each insertion site. These scleral sutures are tied together to tighten and advance the plication. The bulge created by the advancing muscle typically resolves within a few weeks and is not cosmetically noticeable. Video adapted from Pediatric Ophthalmology and Strabismus (Oxford University Press, 2012).