his study evaluates the benefit of using Tutopatch® to elongate the extraocular muscles in patients with third nerve palsy who have residual strabismus after unsuccessful surgery and no other surgical options considered to be appropriate. The study included nine patients mean age 39 years at surgery (range 33-70). There were three bilateral palsies and six unilateral, due to trauma, neurosurgery, intracranial haemorrhage, tumour or unknown cases. All had prior surgery. Cases were split to three groups: (1) one patient with vertical deviation – superior rectus surgery only, (2) three patients with partial third – lateral rectus surgery, and (3) five patients with complete third – lateral rectus surgery with splitting of the graft and lateral rectus. Good outcome criteria were met for four patients. All nine cases had improvement of their strabismus – seven were satisfied and two required further surgery. Overall, generally satisfactory results were obtained. Overcorrection was aimed for, but cases still had reduction in surgical effect over time. The authors acknowledge study limitations of small sample size, variance in extent of the palsies, retrospective study and inconsistency in measurements. They conclude Tutopatch® is a safe method and offers an extra surgical option for residual strabismus management.