A Case of Congenital Absence of the Superior Oblique Muscle Treated With Anterior and Nasal Transposition of the Inferior Oblique Muscle

Jin-hwan Park; Deoksun Cha; Yoonae A. Cho; Young-Woo Suh

doi:10.3341/jkos.2010.51.7.1032

Journal List > J Korean Ophthalmol Soc > v.51(7) > 1008607

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Park, Cha, Cho, and Suh: A Case of Congenital Absence of the Superior Oblique Muscle Treated With Anterior and Nasal Transposition of the Inferior Oblique Muscle

Original Article

J Korean Ophthalmol Soc 2010;51(7):1032-1035.

Published online: 31 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.7.1032

A Case of Congenital Absence of the Superior Oblique Muscle Treated With Anterior and Nasal Transposition of the Inferior Oblique Muscle

Jin-hwan Park, MD, Deoksun Cha, MD, Yoonae A. Cho, MD, PhD, Young-Woo Suh, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Young-Woo Suh, MD, PhD, Department of Ophthalmology, Korea University Anam Hospital #126-1 Anamdong 5-ga, Sungbuk-gu, Seoul 136-701, Korea Tel: 82-2-920-5521, Fax: 82-2-924-6820, E-mail: mdsuh77@naver.com

Received 14 December 2009 Accepted 18 May 2010

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 patient with absence of the superior oblique (SO) muscle of the left eye, who showed improvement after anterior and nasal transposition of the inferior oblique muscle for left hyperdeviation and right head tilt.

Case summary

A two-year-old boy presented with hypertropia of the left eye and right head tilt. Alternate prism-cover test in the primary position demonstrated 18 prism diopters (PD) of left hypertropia, which increased to 35 PD in the left head tilt position. A version test demonstrated overaction of the left inferior oblique muscle and underaction of the left superior oblique muscle. As an orbit CT scan showed absence of the SO muscle, the patient was diagnosed with congenital absence of SO and left anterior and nasal transposition of the inferior oblique muscle was performed. Three weeks after surgery, the patient presented with orthotropia at distant and near. The version test revealed normal oblique muscles. There was no vertical deviation shown on the Bielschowsky head tilt test. The abnormal head posturing was no longer observed.

Conclusions

The authorsreport a patient manifesting abnormal head posture and hypertropia, diagnosed with absence of SO muscle, which was successfully corrected using anterior and nasal transposition of the inferior oblique muscle.

Keywords: Absence of superior oblique muscle, Anterior and nasal transposition of inferior oblique muscle

References

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Figure 1.

(A) Before surgery. The child showed right head tilt preoperatively. (B) Three weeks after surgery. The head tilting disappeared after anterior and nasal transposition of the inferior oblique muscle.

Figure 2.

(A) Before surgery. The patient shows severe superior oblique underaction and inferior oblique overaction of the left eye. (B) Three weeks after surgery. The dysfunction of both oblique muscles in the left eye improved significantly.

Figure 3.

(A) Preoperative forced head tilt test. The patient showshypertropia on left side head tilt. (B) Postoperative forced head tilt test. There is no vertical deviation on head tilt test.

Figure 4.

The superior oblique muscle of the left eye is not found on CT scan.

Figure 5.

The inferior oblique muscle is transposed anterior-nasally to the nasal border of the insertion of the inferior rectus muscle. A black arrow indicates the medial border of the inferior rectus muscle insertion, and a yellow arrowindicates the new insertion site of the inferior oblique muscle.

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