Adjustable Suture Modifier

Adjustable sutures should only be considered in patients who are able to cooperate post-operatively under topical anesthesia. This is often confirmed by performing a “Q tip test,” where the conjunctiva is manipulated with a cotton swab to see how the patient reacts. Several studies have shown the efficacy in reducing the need for repeat operations after using an adjustable technique (Haridas et al. Cochrane Database Syst Rev 7:CD004240, 2013). It is surgeon dependent whether to opt for an adjustable suture technique, based on the patient presentation. Many surgeons will reserve adjustable strabismus surgery for patients with thyroid eye disease, or adult reoperations.