Superior oblique tucks for apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis

Jonathan M Holmes, Sarah R. Hatt, David A. Leske

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction: Apparent inferior oblique overaction and apparent superior oblique underaction are common in strabismus associated with craniosynostosis, and in many cases are likely due to excyclotorsion of the globes, with the rectus muscles acting with oblique vectors. We present a patient with craniosynostosis who underwent bilateral superior oblique tucks to specifically address the excyclotorsion of the globes. Methods: A 16-year-old male with Saethre-Chotzen syndrome presented with apparent bilateral inferior oblique overaction and apparent bilateral superior oblique underaction. He had 30 prism diopter (PD) esotropia and 5 PD left hypertropia by simultaneous prism and cover test (SPCT) at distance and near fixation. Fundus exam revealed marked excyclotorsion of both globes. The superior oblique tendons were tucked 10mm bilaterally, using a 6-0 mersilene suture and the medial rectus muscles were recessed 5.5mm on an adjustable suture with a 10-mm inferior displacement. Surgical results were reviewed at 6 weeks and 2 years postoperatively. Results: At 6 weeks and 2 years postoperatively, apparent inferior oblique overaction, apparent superior oblique underaction, and V-pattern esotropia were markedly improved. At 2 years, SPCT measurements were 8 PD esotropia in primary position at distance and 4 PD esotropia and 3 PD left dissociated vertical deviation at near. Conclusions: Bilateral superior oblique tucks are useful in addressing the excyclotorsion that leads to apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis.

Original languageEnglish (US)
Pages (from-to)111-115
Number of pages5
JournalStrabismus
Volume18
Issue number3
DOIs
StatePublished - Sep 2010

Fingerprint

Esotropia
Craniosynostoses
Strabismus
Sutures
Acrocephalosyndactylia
Muscles
Tendons

Keywords

  • Craniosynostosis
  • Excyclotorsion
  • Superior oblique tuck
  • Surgery
  • V-pattern

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Superior oblique tucks for apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis. / Holmes, Jonathan M; Hatt, Sarah R.; Leske, David A.

In: Strabismus, Vol. 18, No. 3, 09.2010, p. 111-115.

Research output: Contribution to journalArticle

@article{033700cb24834ec283626b7f7aadc930,
title = "Superior oblique tucks for apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis",
abstract = "Introduction: Apparent inferior oblique overaction and apparent superior oblique underaction are common in strabismus associated with craniosynostosis, and in many cases are likely due to excyclotorsion of the globes, with the rectus muscles acting with oblique vectors. We present a patient with craniosynostosis who underwent bilateral superior oblique tucks to specifically address the excyclotorsion of the globes. Methods: A 16-year-old male with Saethre-Chotzen syndrome presented with apparent bilateral inferior oblique overaction and apparent bilateral superior oblique underaction. He had 30 prism diopter (PD) esotropia and 5 PD left hypertropia by simultaneous prism and cover test (SPCT) at distance and near fixation. Fundus exam revealed marked excyclotorsion of both globes. The superior oblique tendons were tucked 10mm bilaterally, using a 6-0 mersilene suture and the medial rectus muscles were recessed 5.5mm on an adjustable suture with a 10-mm inferior displacement. Surgical results were reviewed at 6 weeks and 2 years postoperatively. Results: At 6 weeks and 2 years postoperatively, apparent inferior oblique overaction, apparent superior oblique underaction, and V-pattern esotropia were markedly improved. At 2 years, SPCT measurements were 8 PD esotropia in primary position at distance and 4 PD esotropia and 3 PD left dissociated vertical deviation at near. Conclusions: Bilateral superior oblique tucks are useful in addressing the excyclotorsion that leads to apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis.",
keywords = "Craniosynostosis, Excyclotorsion, Superior oblique tuck, Surgery, V-pattern",
author = "Holmes, {Jonathan M} and Hatt, {Sarah R.} and Leske, {David A.}",
year = "2010",
month = "9",
doi = "10.3109/09273972.2010.507613",
language = "English (US)",
volume = "18",
pages = "111--115",
journal = "Strabismus",
issn = "0927-3972",
publisher = "Informa Healthcare",
number = "3",

}

TY - JOUR

T1 - Superior oblique tucks for apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis

AU - Holmes, Jonathan M

AU - Hatt, Sarah R.

AU - Leske, David A.

PY - 2010/9

Y1 - 2010/9

N2 - Introduction: Apparent inferior oblique overaction and apparent superior oblique underaction are common in strabismus associated with craniosynostosis, and in many cases are likely due to excyclotorsion of the globes, with the rectus muscles acting with oblique vectors. We present a patient with craniosynostosis who underwent bilateral superior oblique tucks to specifically address the excyclotorsion of the globes. Methods: A 16-year-old male with Saethre-Chotzen syndrome presented with apparent bilateral inferior oblique overaction and apparent bilateral superior oblique underaction. He had 30 prism diopter (PD) esotropia and 5 PD left hypertropia by simultaneous prism and cover test (SPCT) at distance and near fixation. Fundus exam revealed marked excyclotorsion of both globes. The superior oblique tendons were tucked 10mm bilaterally, using a 6-0 mersilene suture and the medial rectus muscles were recessed 5.5mm on an adjustable suture with a 10-mm inferior displacement. Surgical results were reviewed at 6 weeks and 2 years postoperatively. Results: At 6 weeks and 2 years postoperatively, apparent inferior oblique overaction, apparent superior oblique underaction, and V-pattern esotropia were markedly improved. At 2 years, SPCT measurements were 8 PD esotropia in primary position at distance and 4 PD esotropia and 3 PD left dissociated vertical deviation at near. Conclusions: Bilateral superior oblique tucks are useful in addressing the excyclotorsion that leads to apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis.

AB - Introduction: Apparent inferior oblique overaction and apparent superior oblique underaction are common in strabismus associated with craniosynostosis, and in many cases are likely due to excyclotorsion of the globes, with the rectus muscles acting with oblique vectors. We present a patient with craniosynostosis who underwent bilateral superior oblique tucks to specifically address the excyclotorsion of the globes. Methods: A 16-year-old male with Saethre-Chotzen syndrome presented with apparent bilateral inferior oblique overaction and apparent bilateral superior oblique underaction. He had 30 prism diopter (PD) esotropia and 5 PD left hypertropia by simultaneous prism and cover test (SPCT) at distance and near fixation. Fundus exam revealed marked excyclotorsion of both globes. The superior oblique tendons were tucked 10mm bilaterally, using a 6-0 mersilene suture and the medial rectus muscles were recessed 5.5mm on an adjustable suture with a 10-mm inferior displacement. Surgical results were reviewed at 6 weeks and 2 years postoperatively. Results: At 6 weeks and 2 years postoperatively, apparent inferior oblique overaction, apparent superior oblique underaction, and V-pattern esotropia were markedly improved. At 2 years, SPCT measurements were 8 PD esotropia in primary position at distance and 4 PD esotropia and 3 PD left dissociated vertical deviation at near. Conclusions: Bilateral superior oblique tucks are useful in addressing the excyclotorsion that leads to apparent inferior oblique overaction and V-pattern strabismus associated with craniosynostosis.

KW - Craniosynostosis

KW - Excyclotorsion

KW - Superior oblique tuck

KW - Surgery

KW - V-pattern

UR - http://www.scopus.com/inward/record.url?scp=77956702693&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77956702693&partnerID=8YFLogxK

U2 - 10.3109/09273972.2010.507613

DO - 10.3109/09273972.2010.507613

M3 - Article

C2 - 20843188

AN - SCOPUS:77956702693

VL - 18

SP - 111

EP - 115

JO - Strabismus

JF - Strabismus

SN - 0927-3972

IS - 3

ER -