Bilateral Superior Oblique Tenectomy for Exotropia with Vertical and Lateral Incomitance

Abstract

Bilateral superior oblique overaction is usually associated with A pattern strabismus and in some cases, a compensatory head tilt can be present. We report a case of a 9 year old girl who presented to our outpatient department with complaints of outward deviation of eyes since 2 years. On examination, she had a compensatory face turn to the right. Her visual acuity was 6/6 in both eyes. Cover test showed exotropia with A pattern, lateral incomitance and an asymmetric superior oblique overaction (SOOA) in both eyes. Fundus examination showed intorsion in both eyes. Bilateral asymmetric superior oblique tenectomy was performed which corrected the compensatory head posture and incomitant exotropia along with collapse of A pattern. Hence, bilateral superior oblique tenectomy is an effective tool for SOOA presenting with A pattern.