Wallace DK. von Noorden GK.
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
Clinical characteristics and surgical management of congenital absence of the superior oblique tendon.
American Journal of Ophthalmology. 118(1):63-9, 1994 Jul 15.
We reviewed clinical characteristics and surgical results of nine patients
with surgically proved congenital absence of the superior
oblique tendon. The following factors indicate absence of
the tendon in the setting of superior
oblique palsy: (1) an associated horizontal
deviation, (2) amblyopia, (3) a large hypertropia in primary position, (4) spread of comitance, and (5) pseudo-overaction of the contralateral superior oblique muscle. The nine patients required a total of 19 operations to correct their vertical and horizontal deviations. Surgical management was based on the preoperative action of the inferior oblique muscle, the amount of hypertropia in primary position, and intraoperative forced ductions. After their operations, eight of nine patients had improvement in or abatement of their symptoms, and seven of seven with preoperative head tilts had improvement of their head position.