Overaction of the inferior oblique muscle can coexist with other childhood ocular misalignments, either eyes that cross or eyes that turn outward. These two conditions may coexist with apattern and vpattern occurring due to dysfunction of oblique. We demonstrate the correlation between the traction test. Primary inferior oblique muscle overaction has the characteristics of a muscle that primarily has decreased elasticity, the superior rectus overaction contraction syndrome appears to represent a muscle that is strengthened, and inferior oblique overaction secondary to ipsilateral superior oblique palsy has elements of both decreased elasticity. Inferior oblique definition of inferior oblique by medical. The muscle runs from the medial corner of the orbit to the lateral aspect of the globe, its length approximately paralleling the tendon of insertion of the superior oblique muscle. 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. Materials and methods this was a prospective study conducted at a tertiary care hospital in. Comparison of inferior oblique muscle weakening by. The effect of graded recession and anteriorization on unilateral superior oblique palsy kun moon, md, seyoup lee, md department of ophthalmology, college of medicine, dongsan medical center, keimyung university, daegu, korea purpose. Superior oblique overaction in patients with true browns. Pdf hangback recession of inferior oblique muscle in v. The oblique muscles are abductors so inferior oblique overaction causes excessive.
Muscle tissue in the higher animals is classified as striated, smooth, or cardiac. Excessive elevation of the eye in adduction has traditionally been termed inferior oblique overaction. A left inferior oblique overaction results in a left hypertropia in primary position, which increases in right gaze. This syndrome is defined by y pattern strabismus with exotropia in upgaze. Underacting inferior oblique muscle following myectomy or. A case of marcus gunn jaw winking and pseudo inferior oblique. Results bilateral superior oblique muscle overaction, which corresponds to a backward pitch in lateraleyed animals, can occur when structural lesions involving the brainstem or cerebellum increase central otolithic input to the extraocular muscle subnuclei that modulate downward extraocular muscle tonus. Inferior oblique overaction develops in 72% of patients with infantile esotropia but generally is not recognized until the. The pen, the pencil, and the inferior oblique jaapos. Sep 15, 2017 we present a novel variation of the traction test of the inferior oblique io muscle. Pseudo inferior oblique overaction associated with y and v patterns. There is marked abduction and hypertropia of the adducting eye when elevation is carried out in side.
Comparison of surgical approaches to inferior oblique overaction. Inferior oblique overaction iooa is a common condition seen by pediatric ophthalmologists, either primary or with other forms of strabismus. Inferior oblique muscle surgery pediatric ophthalmology pa. Multiple mechanisms of extraocular muscle overaction. 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. A case of marcus gunn jaw winking and pseudo inferior. To compare the outcomes of surgical procedures in the treatment of inferior oblique muscle overaction iooa as a common disorder of ocular motility. Inferior oblique muscle definition of inferior oblique. The adducting eye right eye is free to manifest the overaction. Anterior transposition and myectomy were compared to evaluate the surgical results in inferior oblique overaction. The effect of graded recession and anteriorization on. Inferior oblique zmyotomy for hypertropia correction in.
The main measures were the type of inferior oblique overaction iooa, pre and postoperative amount of iooa, and horizontal deviations in. A and vpatterns and oblique muscle overaction elsevier health. The inferior oblique also obliquus inferior, inferior oblique muscle, inferior oblique extraocular muscle, latin. Contralateral inferior oblique overaction has been reported after surgeries for unilateral inferior oblique overaction. It is called secondary when it accompanies paresis or palsy of the inferior oblique muscle s antagonist superior oblique muscle or yoke superior rectus muscle. Pdf uses of the inferior oblique muscle in strabismus. This retrospective study was performed on patients with primary and secondary iooa who underwent three. We demonstrate the correlation between the traction test and clinically graded io overaction and describe the. Pdf surgical treatments in inferior oblique muscle overaction. For clinical purposes, almost all cases of bilateral superior oblique muscle overaction can be considered primary, because paralysis of the inferior rectus and inferior oblique muscles is uncommon. Inferior oblique muscle an overview sciencedirect topics. We wanted to examine the effect of graded recession and anteriorization of the inferior oblique. The muscle runs from the medial corner of the orbit to the. 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.
Inferior oblique overaction in infantile esotropia. We noted no overaction or limitation of the right superior rectus rsr or. Surgical treatments in inferior oblique muscle overaction. Primary inferior oblique muscle overaction has the characteristics of a muscle that primarily has decreased elasticity, the superior rectus overactioncontraction syndrome appears to represent a muscle that is strengthened, and inferior oblique overaction secondary to ipsilateral superior oblique palsy has elements of both decreased elasticity. Clinicoradiologic findings of entrapped inferior oblique. Overaction of the inferior oblique muscle is a commonly observed component of childhood strabismus, particularly infantile esotropia and exotropia. Inferior oblique overaction develops in 72% of patients with infantile esotropia but generally is not recognized until the patient is between 2 and 4 years of age. Postulating a role for connective tissue elements in inferior oblique muscle overaction an american ophthalmological society thesis by david stager jr md, linda k.
Comparison of inferior oblique myectomy to recession for. Inferior oblique muscle radiology reference article. Excessive action of this muscle produces an overelevation of the eye when the patient turns the eye inward. Unilateral inferior oblique muscle myectomy and recession in. This inferior oblique overaction iooa may be either primary or it may be secondary to ipsilateral superior oblique palsy or contralateral superior rectus palsy.
If the difference between upgaze and downgaze is as high as 3040 pd in a patient with v pattern and inferior oblique overaction as in the first patient whose pictures are given. Browns syndrome from an inferior oblique palsy, but which also alerts the examiner to the presence of an inferior rectus. We present a novel variation of the traction test of the inferior oblique io muscle. In our study, we found contralateral inferior oblique overaction in 1 out of 6 16. Primary inferior oblique overaction is commonly associated with congenital esotropia, with the oblique overaction usually presenting after 1 year of age. One can ensure that the abducting eye is fixing by covering the adducting eye with an occluder or ones thumb. Inferior oblique muscle overaction how is inferior. Unilateral primary inferior oblique overaction is unusual and many cases may actually represent very asymmetric bilateral inferior oblique overaction. Because true hyperinnervation is not usually present, this phenomenon is better termed elevation in adduction. Read a case of marcus gunn jaw winking and pseudo inferior oblique overaction, american journal of ophthalmology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Chicago, illinois overaction of an inferior oblique is ordinarily thought to result from a paresis of the homolateral superior oblique or of the contralateral superior rectus.
Inferior oblique myectomy strabismus surgery on vimeo. The eye is elevated in adduction, both horizontally and in upgaze fig 101. The inferior oblique muscle has its origin on the maxillary bone just posterior to the inferior medial orbital rim and lateral to the nasolacrimal canal. The actions of the inferior oblique are responsible for moving the visual gaze up and out.
To further define the clinical features of patients with inferior oblique muscle overaction iooa and evaluate the surgical results. Surgery to weaken the muscle can alleviate this condition. To evaluate and quantify the effect of inferior oblique muscle weakening on horizontal deviations. Left browns syndrome with overaction of the ipsilateral superior oblique, widening of the left palpebral fissure on adduction, and the presence of a downshoot during adduction of the affected eye. Uses of the inferior oblique muscle in strabismus surgery article pdf available in middle east african journal of ophthalmology 223. Here we describe the outcomes of inferior oblique zmyotomy for the management hypertropia resulting from inferior oblique overaction, previous surgery or superior oblique palsy. 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. Overaction definition of overaction by the free dictionary. There is marked abduction and hypertropia of the adducting eye when elevation is carried out in side gaze, but there is no hypertropia. Inferior oblique muscle weakening procedures ento key. Jan 01, 2001 read a case of marcus gunn jaw winking and pseudo inferior oblique overaction, american journal of ophthalmology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Overaction of the inferior oblique muscle is termed primary when it is not associated with superior oblique muscle paralysis. 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. Purpose to compare inferior oblique io myectomy with recession for the treatment of superior oblique so palsy.
Overrecessed or slipped inferior rectus muscles will also cause an a. Find out information about inferior oblique muscle. Patients were excluded if io muscle surgery was bilateral, combined with other vertical muscle surgery and if. Postulating a role for connective tissue elements in inferior. Inferior oblique muscle overaction how is inferior oblique. To further define the clinical features of patients with inferior oblique muscle overaction iooa and evaluate the surgical results in a subgroup of these patients. To report the efficacy of inferior oblique zmyotomy for the treatment of hypertropia in children. Pdf surgical treatments in inferior oblique muscle. Comparison of inferior oblique muscle weakening by anterior. The function of the oblique muscles was studied by comparing the coordinated movement of the two eyes in cardinal fields of gaze, up and right, up and left, down and right, and down and left.
May 04, 20 to compare the outcomes of surgical procedures in the treatment of inferior oblique muscle overaction iooa as a common disorder of ocular motility. Postoperative outcomes in terms of residual inferior oblique overaction were compared. A lambda pattern is most frequently associated with bilateral superior oblique over action. To compare the localization and density of collagens i, iv, vi, and elastin, the major protein components of connective. 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. Intraoperative intorsional traction test of the inferior. When performing versions to test for inferior oblique overaction, make sure the abducting eye is fixing, so the adducting fellow eye is free to manifest an upshoot. Synkinetic overaction of the inferior oblique muscle. Postulating a role for connective tissue elements in. Right incyclotorsion was positive compared to the left side. Comparison of graded inferior oblique recession to graded.
Inferior oblique muscle overaction how is inferior oblique muscle overaction abbreviated. Inferior oblique muscle overaction iooa manifests by overelevation of the eye in adduction and is frequently associated with horizontal deviations. Backgroundaims among the various weakening techniques of inferior oblique muscle overaction, the most commonly used techniques include myectomy, recession, and anterior transposition. Sensorimotor and orbital anatomical mechanisms have been invoked to explain primary oblique muscle overaction.
It passes below the inferior rectus muscle before inserting into. To compare the localization and density of collagens i, iv, vi, and elastin, the major protein components of connective tissue, in the inferior oblique muscle of patients with overelevation in adduction and in controls and to characterize changes. All patients with hypertropia undergoing inferior oblique zmyotomy during a 4 year period between june 2011 and june 2015 were included in the study. Intraoperative intorsional traction test of the inferior oblique. Hangback recession of inferior oblique muscle in vpattern strabismus with inferior oblique overaction. A weakening procedure for overaction of the inferior oblique muscle and 4th nerve superior oblique palsy performed through a culdesac inferior fornix incision. It is called secondary when it accompanies paresis or palsy of the inferior oblique muscles antagonist superior oblique muscle or yoke superior rectus muscle. Superior oblique muscle overaction go to academy store learn more and purchase. 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. The inferior oblique muscle function values also mirrored this trend so that most of the myectomies demonstrated a reduced inferior oblique overaction with improved superior oblique function. 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. Pseudo inferior oblique overaction, clinical findings.
Supraduction restriction and motility disturbance of the inferior oblique muscle are observed in the right eye with overaction of its yoke muscle, the left superior rectus. It is reported in 70% of patients with esotropia and 30% of patients with exotropia. Primary inferior oblique overactionmanagement by inferior oblique. Despite marked abduction of either eye when it elevated in adduction, no patient had elevation of the adducting eye on direct. The inferior oblique muscle or obliquus oculi inferior is a thin, narrow muscle placed near the anterior margin of the floor of the orbit.
Inferior oblique muscle article about inferior oblique. Quantification of upshoot in inferior oblique overaction. Surgical treatments in inferior oblique muscle overaction ncbi. A vpattern may be present but it will be relatively small usually 5 to 10 pd. Pdf postulating a role for connective tissue elements in. To compare the efficacy of inferior oblique myectomy and anterior transposition for correcting inferior oblique overaction.
The inferior oblique muscle is one of six extraocular muscles that control eye movements. Unilateral inferior oblique muscle myectomy and recession. Underaction of the right inferior rectus rir and right superior oblique rso muscles associated with downgaze limitations were evident, but io overaction of the right eye was determined to be minimal. The major advantage of the recession is that it allows the weakening procedure to be titrated according to the severity of the overaction fig. Inferior oblique overaction and superior oblique paresis result in vpatterns. Apr 12, 2020 the inferior oblique muscle is one of six thin, extraocular muscles responsible for eye movement. Inferior oblique overaction may be primary and of unknown etiology, or secondary to a congenital superior oblique palsy, as covered in chapter 19. Nov 21, 2003 inferior oblique muscle overaction may cause a socially noticeable vertical hypertropia of the affected eye in primary position and contralateral gaze andor symptomatic diplopia and asthenopia. Superior oblique overaction in patients with true browns syndrome. Inferior oblique definition of inferior oblique by.
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