Fig. 11. Insertion of the orbital layer of the medial rectus (MR) on its pulley. A. Surgical exposure after engagement of the MR tendon on a hook used to maintain abduction. After posterior displacement of the anterior pulley slings by blunt dissection, the insertion of the MR orbital layer onto the glistening white tissue of the orbital surface of the pulley suspension is seen to consist of multiple stout bands resistant to further blunt dissection. (Photograph by Sei Yeul Oh, MD, and the author.) B. Cadaveric exposure of human MR pulley. The smooth-muscle-containing attachment of the pulley to the anterior lacrimal crest has been disinserted and marked with a white suture. Tension applied by retractors distends the white pulley ring to emphasize its circumferential nature. (Photographs courtesy of Robert Alan Goldberg, MD.)