J Korean Ophthalmol Soc.  2011 Sep;52(9):1128-1134.

Secondary Superior Oblique Overaction after Inferior Oblique Muscle Myectomy in a Patient Misdiagnosed with Inferior Oblique Muscle Overaction

• Kim HK
• Lee YC

Abstract

PURPOSE
To report a case of superior oblique muscle tenotomy in a patient with suspected bilateral inferior oblique muscle overaction. The patient showed secondary superior oblique muscle overaction and inferior oblique muscle underaction after inferior oblique muscle myectomy.
CASE SUMMARY
The patient showed V-pattern exotropia with suspected bilateral inferior oblique muscle overaction. After bilateral lateral rectus muscle recession with bilateral inferior oblique muscle myectomy, the patient showed secondary esotropia and inferior oblique underaction. After the surgery, progressive secondary superior oblique muscle overaction continued and finally, a superior oblique muscle tenotomy was performed. After the superior oblique muscle tenotomy, the superior oblique muscle overaction was corrected but the inferior oblique muscle underaction continued.
CONCLUSIONS
After an inferior oblique muscle myectomy, secondary superior oblique muscle overaction can develop. Thus, caution should be taken in diagnosing inferior oblique muscle overaction in patients who show minimally inferior oblique muscle overaction as well as the surgical methods chosen.

Keyword

Consecutive esotropia; Inferior oblique muscle overaction; Secondary Inferior oblique muscle underaction; Secondary superior oblique muscle overaction; V-pattern exotropia

MeSH Terms

Esotropia
Exotropia
Humans
Muscles
Tenotomy