Surgery on the Inferior Oblique Muscle

Abstract

Surgery is performed more commonly on the inferior oblique muscle than on any other cyclovertical muscle. Surgical access to the inferior oblique muscle and procedures designed to alter the effect of contraction of the inferior oblique muscle on the globe are relatively straightforward and complications are infrequent in experienced hands. The most common indications for surgery on the inferior oblique muscle include superior oblique palsy, primary inferior oblique overaction, V-pattern horizontal strabismus with inferior oblique overaction, and dissociated vertical deviation associated with inferior oblique overaction. Accordingly, most operations on the inferior oblique muscle are designed to diminish its function. Weakening procedures on the inferior oblique muscle are numerous and include myotomy, myectomy, recession, marginal myotomy, disinsertion, anterior transposition, and denervation and extirpation. The most recently described weakening operations on the inferior oblique muscle are nasal myectomy and anterior and nasal transposition. The techniques required to perform each of these procedures are reviewed in this chapter.