Diagnosis and Surgical Options in Superior Oblique Surgery

Frequency of the superior rectus muscle overaction/contracture syndrome in unilateral fourth nerve palsy

“…Classifications of the different clinical presentations of unilateral trochlear nerve palsy have been published by several authors. [12][13][14][15] It would be difficult for us to classify all of our patients with superior rectus muscle overaction/contracture syndrome into 1 of these groups, although they would probably fit best in group 5 of Souza-Dias' classification of patients with hypertropia larger across the superior field 15 ; however, some of our patients also had a large deviation when looking toward the ipsilateral lower field due to the superior rectus contracture. The evidence of restriction to depression was not always clear clinically, but it could be demonstrated during surgery with positive forced duction testing in abduction.…”

Multiple Mechanisms of Extraocular Muscle “Overaction”

“…Common examples include primary inferior oblique muscle overaction (IO-OA) that often accompanies horizontal strabismus, 11 overaction of the IO that is secondary to ipsilateral superior oblique (SO) palsy, [12][13][14][15] and the superior rectus (SR) overaction/contracture syndrome of Jampolsky that can occur with ipsilateral SO palsy. [16][17][18][19][20] Even in these circumstances, the term overaction is inadequate because many different situations can result in an increase in a muscle's force.…”

Surgery to Treat Residual Acquired Excyclotropia without Changing the Primary Position Vertical Deviation: A Case Report

“…The traditional surgical approaches to reduce excyclotorsion in the presence of a primary position vertical tropia is a SO 7 tuck (Knapp and Moore, 1976;Morris et al, 1992). No change in the primary position vertical deviation was reported as a feature of the Harada Ito procedure (Harada and Ito, 1964) or Fells modification thereof (Fells, 1974), yet primary position hypotropia can occur, leading some to prefer an adjustable modified Harada-Ito procedure (Elsas, 1988).…”

“…Surgical management options of symptomatic residual excyclotropia include a superior oblique (SO) tuck (Knapp and Moore, 1976;Morris et al, 1992) or a Harada-Ito procedure (Harada and Ito, 1964) which is commonly modified (Fells, 1974). Horizontal transposition procedures of the vertical rectus muscles have been described as an alternative surgical option for cyclotropia (Okamoto et al, 2015;von Noorden et al, 1996;Ohmi et al, 1997).…”