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A young male patient with unilateral pathological myopia complained of selective hypotropia for distance with exophoria. Due to large globe, a notable amount of inferior scleral show was evident. In this scenario, extensive dissection along inferior rectus muscle to perform a Faden procedure would have worsened the inferior scleral show. Thus, as an alternative, the anterior procedure, that is, “inferior rectus muscle Y-splitting procedure with 4-mm recession” was undertaken. At the end of 3 months follow up, the troublesome selective hypotropia for distance disappeared significantly with very little changes along the lower lid position. Therefore, in presence of specific anatomical limitations, the inferior rectus muscle Y splitting procedure can be considered in lieu of Faden procedure for near-distance hypotropia disparity.

Inferior rectus muscle Y splitting procedure for near-distance hypotropia disparity: an alternative to the Faden procedure