J Korean Ophthalmol Soc.  2012 Oct;53(10):1493-1499.

Clinical Manifestations of Inferior Oblique Overaction in Patients with Horizontal Strabismus

• Choi DK
• Choi MY

Abstract

PURPOSE
To investigate the clinical manifestations of and the surgical success rates in patients with horizontal strabismus and inferior oblique overaction (IOOA).
METHODS
The patients included in the present study had received myectomy for correction of IOOA and had at least 3 months of follow-up. The patients were divided into 2 groups; patients who received myectomy and surgery for horizontal strabismus simultaneously (combined group, 74 eyes of 49 patients) and patients who received myectomy only (myectomy group, 29 eyes of 24 patients). Chief complaints, head tilt, bilaterality of IOOA, ocular torsion, and the surgical success rates were analyzed.
RESULTS
In the combined group, 51% of the chief complaints were horizontal deviation, and in the myectomy group 42% were upward deviation and 29% were head tilt. Objective head tilt was 29% in the combined group and 54% in the myectomy group and the difference was significant. There was no significant difference statistically in the success rate of myectomy.
CONCLUSIONS
The frequency of symptoms associated with IOOA in the combined group was lower than in the myectomy group. Therefore, preoperative examination regarding IOOA should be carefully performed in patients who are planning a horizontal strabismus surgery because there was no difference in surgical success rate between the 2 groups, the association with horizontal strabismus may have no effect on the surgical results of IOOA.

Keyword

Head tilt; Horizontal strabismus; Inferior oblique overaction

MeSH Terms

Eye
Follow-Up Studies
Head
Humans
Strabismus

Reference

1. White JW, Brown HW. Occurrence of vertical anomalies associated with convergent and divergent anomalies: a clinical study. Arch Ophthalmol. 1939. 21:999–1009.

2. Parks MM. The weakening surgical procedures for eliminating overaction of the inferior oblique muscle. Am J Ophthalmol. 1972. 73:107–122.

3. Parks MM. The overacting inferior oblique muscle. Am J Ophthalmol. 1974. 77:787–797.

4. Kim JW, Kim MM. The effect of inferior oblique weakening procedures in the congenital superior oblique palsies. J Korean Ophthalmol Soc. 2004. 45:1893–1898.

5. Cho YA. The effect of recession for overaction of the inferior oblique muscle. J Korean Ophthalmol Soc. 1985. 26:517–521.

6. Gillies WE. Simple technique for recession of the inferior oblique muscle. Br J Ophthalmol. 1970. 54:736–739.

7. Stuart JA. Myectomy of the inferior oblique muscle. Am J Ophthalmol. 1964. 57:118–121.

8. Jung JI, Han SH. Anterior transposition of the inferior oblique muscle for treatment of hypertropia in superior oblique muscle palsy. J Korean Ophthalmol Soc. 1999. 40:242–247.

9. Paik HJ, Choi JS. Comparison of recession, anterior transposition, and myectomy for inferior oblique overaction. J Korean Ophthalmol Soc. 2006. 47:600–606.

10. Chang BL, Chang MH, Yang SW. Inferior oblique overaction. J Korean Ophthalmol Soc. 1988. 29:1065–1069.

11. Min BM, Park JH. Comparison between myectomy and anterior transposition on inferior oblique overaction. J Korean Ophthalmol Soc. 1992. 33:977–982.

12. Song BY, Park SW, Park YG. The surgical effects of inferior oblique anteriorization. J Korean Ophthalmol Soc. 2004. 45:995–1000.

13. Kim SY, Han YB, Chang BL. Inferior oblique muscle recession. J Korean Ophthalmol Soc. 1982. 23:91–94.

14. Cho YA. Treatment of marked overaction of inferior oblique: Denervation and Extirpation of Inferior Oblique. J Korean Ophthalmol Soc. 1987. 28:381–386.

15. Nam H, Yoo JM. The effect of anterior transposition with J-deformity for overaction of the inferior oblique muscle. J Korean Ophthalmol Soc. 1997. 38:302–307.

16. Roh IH, Choi MY. The effect of myectomy on the grading of overaction of the inferior oblique muscle. J Korean Ophthalmol Soc. 2006. 47:437–442.

17. Park JH, Kang SH, Choi DG. Analysis of effect of inferior oblique myectomy in patients with inferior oblique overaction. J Korean Ophthalmol Soc. 2011. 52:67–73.

18. Hong JS, Kim MM. Long-term outcome of graded inferior oblique recession. J Korean Ophthalmol Soc. 2006. 47:127–132.

19. Wright KW, Ryan SJ. Color atlas of ophthalmic surgery. strabismus. 1991. 1st ed. Philadelphia: Lippincott;173–199.

20. Duane A. Binocular movements. Arch Ophthalmol. 1933. 9:579–607.

21. Cho YA, Kim SH. Surgical outcomes of intermittent exotropia associated with concomitant hypertropia including simulated superior oblique palsy after horizontal muscles surgery only. Eye (Lond). 2007. 21:1489–1492.

22. Von Noorden G, Campos EC. Binocular vision and ocular motility: theory and management of strabismus. 2002. 6th ed. St. Louis: MO Mosby;396–413.

23. Ahn JH, Lee SG. Comparison of inferior oblique myectomy, recession, and anterior transposition in unilateral congenital superior oblique palsy. J Korean Ophthalmol Soc. 2010. 51:76–80.