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Medial Check Ligament of the Eye

ligamentum checki mediale

The medial check ligament is a fibrous extension of the fascial sheath of the medial rectus muscle, attaching to the medial orbital wall (lacrimal bone and frontal process of maxilla). It is condensed into a triangular fibrous sheet that limits excessive abduction by restricting how far the medial rectus can be stretched. Together with the lateral check ligament and Lockwood ligament it forms the suspensory apparatus of the eyeball within the orbit.

Region: Head & Skull

Biomechanics

Function & Actions

Limits extreme abduction of the globe by acting as a check on medial rectus overextension, and contributes to the fascial sling supporting the eyeball in the orbital cone alongside the other check ligaments.

Clinical Relevance

Clinical Notes

The medial check ligament must be identified and divided during strabismus surgery when recessing the medial rectus muscle, as failure to release the ligament causes undercorrection of esotropia. The check ligaments and Lockwood ligament collectively prevent ptosis of the globe and enophthalmos by providing structural suspension within the orbit. After trauma or orbital decompression surgery, disruption of these fascial condensations can produce inferior globe displacement and diplopia.

Pathology

Common Injuries & Conditions

Strabismus Surgery Complication

Failure to release the medial check ligament during medial rectus recession for esotropia limits the effective muscle lengthening, producing undercorrection of the squint and requiring revision surgery to fully divide the fascial check ligament.