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

Hyun Kyung Kim; Young Choon Lee

doi:10.3341/jkos.2011.52.9.1128

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Kim and Lee: Secondary Superior Oblique Overaction after Inferior Oblique Muscle Myectomy in a Patient Misdiagnosed with Inferior Oblique Muscle Overaction

Original Article

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

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.9.1128

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

Hyun Kyung Kim, MD, PhD¹, Young Choon Lee, MD, PhD²

¹Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, St. Vincent's Hospital, Uijeongbu, Korea

²Suwon, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea

Address reprint requests to Young Choon Lee, MD, PhD Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital #65-1 Geumo-dong, Uijeongbu 480-717, Korea Tel: 82-31-820-3110, Fax: 82-31-847-3418, E-mail: yclee@cmcnu.or.kr

Received 23 February 2010 Revised 22 March 2011 Accepted 5 June 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Consecutive esotropia, Inferior oblique muscle overaction, Secondary Inferior oblique muscle underaction, Secondary superior oblique muscle overaction, V-pattern exotropia

References

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Figure 1.

Preoperative fundus photos. Preoperatively, authors misdiagnosed bilateral excyclotorsions.

Figure 2.

(A) Postoperative 7 month 9-cardinal photos; Bilateral lateral rectus muscle recession (7.0 mm) with bilateral inferior oblique muscle myectomy. Consecutive esotropia and A-pattern esotropia developed. Right eye showed inferior oblique muscle underaction (−1.5) and left eye showed (−1.0) inferior oblique muscle underaction. (B) Postoperative fundus photo showed bilateral incyclotorsions.

Figure 3.

(A) Postoperative 3 year 5 months 9-cardinal photos after secondary operation; Right lateral rectus muscle advancement (5.0 mm) and right inferior oblique muscle exploration. Consecutive esotropia and A-pattern esotropia still remained. Both eyes showed inferior oblique muscle underaction (−2.0) and superior oblique muscle overaction (+3.0). (B) Postoperative fundus photo showed marked bilateral incyclotorsions.

Figure 4.

(A) Postoperative 6 months 9-cardinal photos after tertiary operation; Bilateral superior oblique muscle tenotomy. In primary position, mild esophoria and left hypotropia was noticed. Both eyes still showed inferior oblique muscle underaction (−1.0). Right eye showed mild and left eye had no superior oblique muscle overaction. (B) Postoperative fundus photo showed mild in-cyclotorsion in the right eye and no torsion in the left eye.

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