title: Treatment of inferior oblique paresis with superior oblique silicone tendon expander.
abstract: BACKGROUND
  Patients with inferior oblique eye muscle paresis may show hypotropia and apparent superior oblique muscle overaction on the side of the presumed weak inferior oblique (IO) muscle. We report 8 such patients successfully treated using unilateral silicone superior oblique (SO) tendon expanders.
  
  
  METHODS
  Eight consecutive cases over the course of 6 years from the authors' private practice are described. None had a history of head trauma or a significant neurologic event. All patients showed IO paresis by 3-step test, with incyclotorsion and SO overacton of the hypotropic (paretic) eye. Forced ductions of the hypotropic eye were normal in all cases, and the vertical strabismus was treated with placement of a 7- mm silicone SO tendon expander in the hypotropic (paretic) eye.
  
  
  RESULTS
  Mean preoperative primary position hypotropia was 6.5 prism diopters (PD); mean postoperative was 0.5 PD. Seven of 8 patients had resolution of primary position hypotropia, whereas the eighth was reduced. Mean preoperative SO overaction was 3+; all patients had postoperative resolution of SO overaction. Of 4 patients with preoperative ocular torticollis, mean preoperative head tilt was 9.3 degrees; mean postoperative tilt was 2.9 degrees. Two patients' head tilts had resolved, the other 2 showed improvement. All patients showed preoperative incylclotorsion of the hypotropic (paretic) eye; inclyclotorsion resolved in all patients after the placement of a SO tendon expander.
  
  
  CONCLUSIONS
  The silicone SO tendon expander effectively restores ocular alignment in IO paresis with apparent SO overaction. Associated ocular torticollis can also be improved.
authors.affiliation: Eye Consultants of Atlanta, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia, USA.
authors.forename: Marc F
authors.initials: MF
authors.lastname: Greenberg
authors.forename: Zane F
authors.initials: ZF
authors.lastname: Pollard
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D005133:Eye Movements; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000601:surgery; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D012826:Silicone Elastomers / Q000627:therapeutic use*; D013285:Strabismus / Q000209:etiology / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D015348:Vision, Binocular
chemical_list: D012826:Silicone Elastomers