The medial and lateral check ligaments are fibrous expansions from the sheaths of the medial and lateral rectus muscles that attach to the orbital walls (medial check ligament to the lacrimal bone, lateral check ligament to the lateral orbital wall/Whitnall tubercle). Together with the inferior transverse ligament (Lockwood ligament), they suspend the globe and limit the excursion of the extraocular muscles, preventing excessive medial or lateral displacement of the globe.
Limit excessive contraction of the medial and lateral rectus muscles, preventing over-retraction of the globe and maintaining the globe in the central orbital position during extraocular muscle surgery.
The check ligaments must be identified and released during strabismus surgery when correcting large horizontal deviations, as failure to release them causes post-operative restrictive deviation from tethering. The medial check ligament is specifically addressed during medial orbital wall decompression for Graves orbitopathy, where it tethers the medial rectus muscle sheath to the decompressed wall. Blow-in orbital wall fractures may trap the check ligament within the fracture line.
Correction of large horizontal deviations by medial or lateral rectus muscle recession without releasing the corresponding check ligament produces a restrictive post-operative motility pattern as the check ligament limits the muscle's recession effect; specific check ligament incision improves the range of motility achievable by each recession.
