Fig. 18. A 4 to 7 mm section of a no. 240 silicone band can be used as a spacing material to lengthen the superior oblique tendon medial to the superior rectus muscle in lieu of superior oblique tendon tenotomy. Two double-armed sutures of 7-0 polypropylene (shown secured to the left superior oblique tendon on either side of the Jameson muscle hook) have been passed through the ends of the silicone spacer. After transection between the sutures, the cut ends of the tendon are tied to the spacer. Care must be taken to preserve Tenon's fascia and avoid direct contact of the silicone with the sclera, which predispose to an adherence syndrome postoperatively.