Lee ann remington od, ms, faao, in clinical anatomy and physiology of the visual system third edition, 2012. This retrospective study was performed on patients with primary and secondary iooa who underwent three surgical treatment procedures including disinsertion, myectomy and anterior. Its actions are lateral rotation, elevation and abduction of the eye primary action is extorsion. The effect of inferior oblique muscle z myotomy in patients. Consecutive prospective analysis of all patients undergoing inferior oblique zmyotomy for the treatment of hypertropia and inferior oblique overaction between june 2011 and june 2015 at a single tertiary centre. Surgery of the inferior oblique muscle the treatment of superior oblique palsies is one of the more complicated problems in strabismology and it is more prudent to refer such a patient to a strabologist for management if it is possible. Primary inferior oblique overaction in congenital esotropia, accommodative esotropia, and intermittent exotropia. Unilateral inferior oblique muscle myectomy and recession. A left inferior oblique overaction results in a left hypertropia in primary position, which increases in right gaze. The effect of inferior oblique muscle z myotomy in.
Primary inferior oblique overactionmanagement by inferior. The study was conducted to evaluate the midterm effectiveness of a new surgical approach in the reduction of overaction of the inferior oblique muscle methods. Bilateral inferior oblique overaction, which corresponds to a forward pitch in lateraleyed animals, may result from visual disinhibition of central vestibular pathways to the extraocular muscle subnuclei that modulate upward extraocular muscle tonus. In other words, if i have an inferior oblique overaction in one eye thats advanced and the other eye doesnt really have an oblique overaction, id rather leave it.
Surgical treatments in inferior oblique muscle overaction. Dissociated vertical deviation and inferior oblique overaction. Purpose to compare inferior oblique io myectomy with recession for the treatment of superior oblique so palsy. The actions of the inferior oblique are responsible for moving the visual gaze up and out. Commentary on the outcomes of inferior oblique muscle.
Overaction of the inferior oblique muscle is a commonly observed component of childhood strabismus, particularly infantile esotropia and exotropia. Combined resection and anterior transposition of the inferior oblique muscle for the treatment of moderate to. Soltan sanjari et al are to be commended on their paper surgical treatments in inferior oblique muscle overaction. Pdf surgical treatments in inferior oblique muscle. Recession and anterior transposition of the inferior oblique for treatment of superior oblique palsy. There is marked abduction and hypertropia of the adducting eye when elevation is carried out in side gaze, but there is no hypertropia. Thirty four patients with unilateral inferior oblique overaction were. Alternate explanations for inferior oblique muscle overaction. Only patients with gradual elevation of the eye in adduction in a pattern similar to inferior oblique overaction or patients with hypertropia in the primary position were included. Pseudo inferior oblique overaction associated with y and v. All patients with hypertropia undergoing inferior oblique zmyotomy during a 4 year period between june 2011 and june 2015 were included in the study. Unilateral inferior oblique anterior transposition for.
Disease bioinformatics research of inferior oblique overaction has been linked to strabismus, dysplasia, intraepithelial neoplasia, esotropia, dissociated vertical deviation. Comparative study of unilateral versus bilateral inferior oblique. Journal of american association for pediatric ophthalmology and. The study was conducted to evaluate the midterm effectiveness of a new surgical approach in the reduction of overaction of the inferior oblique muscle. Intraoperative intorsional traction test of the inferior oblique. May 01, 2009 in other words, if i have an inferior oblique overaction in one eye thats advanced and the other eye doesnt really have an oblique overaction, id rather leave it alone. The study of superior oblique overaction has been mentioned in research publications which can be found using our bioinformatics tool below. Objectives to compare the surgical outcomes of inferior oblique io myectomy in congenital superior oblique palsy sop according to the presence of the trochlear nerve identified with highresolution mri. Sensorimotor and orbital anatomical mechanisms have been invoked to explain primary oblique muscle overaction.
Comparing graded anterior transposition with myectomy in primary. The inferior oblique is innervated by the inferior branch of the oculomotor nerve. Unilateral primary inferior oblique overaction is unusual and many cases may actually represent very asymmetric bilateral inferior oblique overaction. For inferior oblique pupils should be up and nasal cardinal testing position of superior and inferior obliques notice. Inferior oblique muscle an overview sciencedirect topics. Inferior oblique muscle article about inferior oblique. To compare the efficacy of inferior oblique myectomy and anterior transposition for correcting inferior oblique overaction. All patients had an eye movement pattern that resembled but was distinctly different from bilateral inferior oblique overaction. Inferior oblique muscle definition of inferior oblique. Data extraction fortyone congenital sop patients without a trochlear nerve absent group and 23 patients with a trochlear nerve present group who underwent io. To investigate clinical findings of the pseudo inferior oblique overaction iooa syndrome and the outcomes of strabismus surgery and to discuss the mechanisms proposed for this disease. Nov 01, 2010 various surgical techniques have been described as weakening procedures of the inferior oblique muscle in inferior oblique muscle overaction iooa including disinsertion, myotomy, myectomy. Unilateral inferior oblique muscle myectomy and recession in. In the article entitled multiple mechanisms of extraocular muscle overaction, dr kushner provided lucid and wellillustrated descriptions of loss of elasticity contracture, true shortening and gain in elasticity expansure, true lengthening of extraocular muscles.
A weakening procedure for overaction of the inferior oblique muscle and 4th nerve superior oblique palsy performed through a culdesac inferior fornix incision. After surgery, about onequarter of the patients with unilateral inferior oblique overaction subsequently developed a contralateral inferior oblique overaction. Arising from the maxillary bone on the inner floor of the eye socket, the inferior oblique muscle courses forward to attach to the sclera of the eye at a point between two muscles that connect to the inferior and lateral poles of the eye, the inferior and lateral recti. A vpattern may be present but it will be relatively small usually 5 to 10 pd. Prospective laboratorybased casecontrol study of inferior oblique muscle specimens from 31 subjects. Expression of myod, insulin like growth factor binding. The inferior oblique also obliquus inferior, inferior oblique muscle, inferior oblique extraocular muscle, latin. Overaction definition of overaction by the free dictionary. Surgery on the inferior oblique io muscle is commonly performed for primary and secondary io overactions, dissociated vertical deviations dvd, and v pattern. The inferior oblique muscle is one of six extraocular muscles that control eye movements. Equatorial scleral anchor for the weakening of the inferior oblique muscle. Surgical weakening of the io muscle can be performed, either unilaterally or bilaterally, to treat primary or secondary inferior oblique overaction. The eye is elevated in adduction, both horizontally and in upgaze fig 101. Clinical manifestations, diagnosis, and surgery of inferior.
Inferior oblique muscle overaction may cause a socially noticeable vertical hypertropia of the affected eye. Inferior oblique muscle radiology reference article. We obtained 20 io muscle samples from so palsy patients with io overaction. Anterior transposition and myectomy were compared to evaluate the surgical results in inferior oblique overaction. Comparison of inferior oblique muscle weakening by. All patients received preoperative krimsky test, synoptophore, cycloplegia. The study of inferior oblique overaction has been mentioned in research publications which can be found using our bioinformatics tool below. To report the efficacy of inferior oblique zmyotomy for the treatment of hypertropia in children. Backgroundaims among the various weakening techniques of inferior oblique muscle overaction, the most commonly used techniques include myectomy, recession, and anterior transposition. They report on a retrospective study of the treatment for inferior oblique overaction iooa performed over a 10year period on 122 eyes utilizing three different surgical techniques to weaken the inferior oblique muscle. Inferior oblique definition of inferior oblique by medical. Jan 28, 2015 the inferior oblique originates from a point in the middle and toward the front of the floor of the eye socket, near the tear duct. Bilateral inferior oblique overaction, which corresponds to a forward pitch in lateraleyed animals, may result from visual. Multiple mechanisms of extraocular muscle overaction.
Patients were excluded if io muscle surgery was bilateral, combined with other vertical muscle surgery and if. Inferior oblique upward and lateraltemporal away superior rectus upward 1 o and medial rotation 2 isolated singular anatomical functions table shows the functions of the four muscle when they perform in isolated fashion and independent of all other muscles in. Review of primitive visuovestibular reflexes and neuroanatomical pathways corresponding to vestibuloocular reflexes, and correlation with known clinical abnormalities in patients with primary oblique muscle overaction. Anterior transposition, disinsertion, inferior oblique muscle overaction, myectomy introduction excessive elevation of the eyeball in intended adduction is a consequence of inferior oblique muscle over action iooa, which is a common disorder of ocular motility 1 and is reported in 70% of patients with esotropia and 30% of. A new surgical treatment was developed consisting of suturing the muscle to the sclera at the gobins point with tendon. None of the patients had inferior oblique overaction postoperatively. Intraoperative intorsional traction test of the inferior. Various surgical techniques have been described as weakening procedures of the inferior oblique muscle in inferior oblique muscle overaction iooa including disinsertion, myotomy, myectomy. Inferior oblique definition of inferior oblique by. Patients diagnosed with ioe during strabismus surgery from march 2017 to september 2018 were included in this retrospective, crosssectional study. Inferior oblique muscle overaction may cause a socially noticeable vertical hypertropia of the affected eye in primary position and contralateral gaze andor. The inferior oblique muscle is one of six thin, extraocular muscles responsible for eye movement. Comparison of inferior oblique muscle weakening by anterior.
Clinical manifestations, diagnosis, and surgery of. Overaction of the inferior oblique muscle is termed primary when it is not associated with superior oblique muscle paralysis. Inferior oblique muscle overaction how is inferior. Pdf surgical treatments in inferior oblique muscle overaction. Comparison of inferior oblique myectomy to recession for.
Patients underwent inferior oblique myectomy on the side of the upshooting eye. Article information, pdf download for comparative study of unilateral. Because true hyperinnervation is not usually present, this phenomenon is better termed elevation in adduction. To identify and compare specific protein levels between overacting inferior oblique io muscles in superior oblique so palsy patients and normal io muscles. Alternate explanations for inferior oblique muscle. Inferior oblique io weakening may affect alignment in primary position due to its contribution. To compare the effects of graded anterior transposition with myectomy in primary inferior oblique overaction iooa. There are occasions, such as in largeangle exotropia and thyroid eye disease, when clinical examination of ocular rotations indicates apparent overaction of both the superior and the inferior oblique muscles in the fields of their vertical action. Please replace this text with the lower left panel information on pp. A 3year, 8monthold female patient underwent disinsertion of right inferior oblique and general anesthesia and following the diagnosis of right superior oblique muscle paralysis. The inferior oblique muscle or obliquus oculi inferior is a thin, narrow muscle placed near the anterior margin of the floor of the orbit. Pseudo inferior oblique overaction, clinical findings. The surgical outcome of inferior oblique recession on. Residual inferior oblique hyperfunction was observed in 3 eyes after recession and in 1 eye after myectomy.
Inferior oblique muscle surgery pediatric ophthalmology pa. To evaluate the results of unilateral inferior oblique anterior transposition ioat for markedly asymmetric dissociated vertical deviation dvd combined with inferior oblique overaction iooa. Chapter 9 discusses the traditional causative role of the oblique muscles in a and vpattern horizontal deviations. Parks mm 1972 the weakening surgical procedures for eliminating overaction of the inferior oblique muscle.
Inferior oblique muscle overaction how is inferior oblique muscle overaction abbreviated. Fulltext pdf rectus muscle resection in graves ophthalmopathy. This syndrome is defined by y pattern strabismus with exotropia in upgaze. Oblique muscle pseudooveraction go to academy store learn more and purchase. May 30, 2018 to identify and compare specific protein levels between overacting inferior oblique io muscles in superior oblique so palsy patients and normal io muscles. To compare the outcomes of surgical procedures in the treatment of inferior oblique muscle overaction iooa as a common disorder of ocular motility. During the first postoperative month, the patients mother found her eye showed a restricted upgaze and limited inferior turn figure 3a, and swelling of the lower right eyelid was also evident due to. Inferior oblique muscle overaction how is inferior oblique. All patients received preoperative krimsky test, synoptophore. Equatorial scleral anchor for the weakening of the.
Surgical management of primary inferior oblique muscle. Oblique muscle pseudo overaction go to academy store learn more and purchase. The obliquus oculi inferior inferior oblique is a thin, narrow muscle, placed near the anterior margin of the floor of the orbit action. Effect of combining inferior oblique muscle weakening procedures. Nevertheless, in this chapter the traditional view of inferior oblique muscle overaction is retained. The actions of the inferior oblique are responsible for moving the visual gaze up and out the inferior oblique originates from the maxillary bone, from the medial part of the. When detected, inferior oblique overaction was asymmetric in 44% of patients and unilateral in 23%. Inferior oblique myectomy strabismus surgery on vimeo. Pdf uses of the inferior oblique muscle in strabismus.
There is marked abduction and hypertropia of the adducting eye when elevation is carried out in side. Does inferior oblique weakening affect horizontal alignment in. Inferior oblique zmyotomy for hypertropia correction in. All patients received preoperative krimsky test, synoptophore, cycloplegia refraction. Overaction definition and meaning collins english dictionary. The inferior oblique originates from a point in the middle and toward the front of the floor of the eye socket, near the tear duct.
It is called secondary when it accompanies paresis or palsy of the inferior oblique muscles antagonist superior oblique muscle or yoke superior rectus muscle. Apr 12, 2020 the inferior oblique muscle is one of six thin, extraocular muscles responsible for eye movement. The inferior oblique is an extraocular muscle, and is attached to the maxillary bone origin and the posterior, inferior, lateral surface of the eye insertion. Oct 10, 2018 here we describe the outcomes of inferior oblique zmyotomy for the management hypertropia resulting from inferior oblique overaction, previous surgery or superior oblique palsy. Jun 15, 2019 to investigate clinical findings of the pseudo inferior oblique overaction iooa syndrome and the outcomes of strabismus surgery and to discuss the mechanisms proposed for this disease.
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