Jensen procedure
The Jensen procedure is a transposition operation that improves abduction in sixth nerve palsy. The surgeon combines it with a recession of the medial rectus or an injection of botulinum toxin.1
The lateral rectus and both vertical rectus muscles are split lengthwise, and the adjacent halves are joined with a nonabsorbable suture.2 The temporal half of the superior rectus is tied to the superior half of the lateral rectus over the equator, and the temporal half of the inferior rectus is joined to the inferior half of the lateral rectus in the same way.3 At least one branch of the anterior ciliary vessels should remain in the nasal half of each vertical rectus.3
Jensen designed the operation to protect the patient against anterior segment ischemia, since the vertical recti stay attached to the globe.2,3 That protection is incomplete, and anterior segment ischemia has followed the procedure.2,3 Botulinum toxin chemodenervation of the medial rectus in place of surgical recession has been advocated to lower the risk.2
More detail
Results are satisfactory in most cases for moving the paretic eye from extreme adduction into primary position and restoring 5 to 10 degrees of abduction.3 In one series of 16 eyes with sixth nerve paralysis, the procedure combined with medial rectus recession reduced the esotropia in primary position by an average of 40 degrees and gave an average postoperative abduction of 18 degrees.3 An overcorrection often appears in the immediate postoperative period, but it is usually transient and disappears on its own.3
Sources (13)
- Pickwell's Binocular Vision Anomalies, ch. 17
- Yanoff and Duker, Ophthalmology (2023), ch. 11.9
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 26
- American Academy of Ophthalmology (2020). Transposition Procedures for Sixth Nerve Palsy. [online] Available at: https://www.aao.org/bcscsnippetdetail.aspx?id=6774bb15-13b5-45a5-b00e-281de94787bb [Accessed 8 May 2024].
- Agarwal, S. (2020). Strabismus Surgery. In: Agarwal, S. (ed.) Strabismus Simplified. Springer, Singapore. https://doi.org/10.1007/978-981-15-2135-0_9
- Kushner, B.J. (2017). Strabismus. In: Olitsky, S.E. (ed.) Pediatric Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-28315-5_10
- Rutstein, R. and Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management. St. Louis: Mosby.
- von Noorden, G. and Campos, E. (2002). Binocular Vision and Ocular Motility. 6th ed. St. Louis: Mosby.
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Reviewed October 2026
Related terms
Nearby in the glossary
- Jensen procedure