To further define the clinical features of patients with inferior oblique muscle overaction iooa and evaluate the surgical results in a subgroup of these. The aim of this research was to assess the surgical results of recession and myectomy procedures in a subgroup of patients who had primary inferior oblique muscle overaction. Surgical treatments in inferior oblique muscle overaction. The possible association between inferior oblique muscle overaction and inferior oblique muscle mass has been a matter of speculation. 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. The inferior oblique also obliquus inferior, inferior oblique muscle, inferior oblique extraocular muscle, latin.
Primary inferior oblique overaction is commonly associated with congenital esotropia, with the oblique overaction usually presenting after 1 year of age. Nov 01, 2010 journal of pediatric ophthalmology and strabismus purpose. Unfortunately, todays pediatric ophthalmologists do not do many motility examinations on adults and so are not struck by the observation that adults do not have oaios. Youve got multiple files documents, spreadsheets, and email attachments from virtually everyone.
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. Patients with cn iv more frequently showed inferior oblique overaction and dissociated vertical deviation. Anatomy and surgery of the inferior oblique muscle. There are occasions, such as in largeangle exotropia and thyroid eye disease, when clinical examination of ocular rotations indicates apparent overaction of both the superior and the inferior oblique muscles in the fields of their vertical action. 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. Inferior transposition of lateral rectus insertions. Occasionally further surgery to the inferior oblique. Inferior oblique myectomy and recession are the most commonly performed procedures to weaken inferior oblique overaction. The inferior oblique is innervated by the inferior branch of the oculomotor nerve. In all of our patients, the hypertropia in the ipsilateral head tilt position was larger than in primary position.
Overaction definition of overaction by the free dictionary. Uses of the inferior oblique muscle in strabismus surgery article pdf available in middle east african journal of ophthalmology 223. This study was performed to evaluate the anatomical position of the inferior oblique muscle and to determine any association between muscle mass and inferior oblique muscle overaction. Brown syndrome differential diagnoses medscape reference. We present a novel variation of the traction test of the inferior oblique io muscle. To compare the efficacy of inferior oblique myectomy and anterior transposition for correcting inferior oblique overaction. The muscle runs from the medial corner of the orbit to the. Bilateral superior oblique weakening recession, tenotomy, tenectomy, or lengthening by nonabsorbable suture, silicone expander, posterior 78 ths or zsplitting of the superior oblique tendon v. When myectomies were performed to weaken the ios, some overacting ios were very bulky but others were of apparently normal size. Multiple mechanisms of extraocular muscle overaction. Learn how to easily bring multiple files together to create a single pdf with adobe acrobat dc. Inferior oblique definition of inferior oblique by medical. Inferior oblique myectomy strabismus surgery on vimeo. Inferior oblique muscle overaction how is inferior oblique.
All patients underwent simultaneous recessionresection procedure in. Antielevation syndrome after unilateral anteriorization of. Is it possible to quantify its effects on horizontal deviations. A weakening procedure for overaction of the inferior oblique muscle and 4th nerve superior oblique palsy performed through a culdesac inferior fornix incision. Merge pdf files combine pdfs in the order you want with the easiest pdf merger available. A vpattern may be present but it will be relatively small usually 5 to 10 pd. A case of contralateral pseudo inferior oblique overaction after unilateral inferior oblique anterior transposition. She had a normal fundus with extorsion of the macula. The most relevant sign of superior rectus muscle overactioncontracture syndrome in unilateral trochlear nerve palsy is a positive bielschowsky head tilt test. Were going to discuss how to manage dissociated vertical deviation dvd and an inferior oblique overaction. Pdf on jan 1, 2018, mahmoudm saleh and others published anteriorization of inferior oblique muscle in management of. This function is of interest to basic anatomists and not to the clinicians.
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 and strengthening. When you are ready to proceed, click combine button. Pdf uses of the inferior oblique muscle in strabismus surgery. Disinsertion on 12 eyes, myectomy on 91 eyes, and anterior transposition of the inferior oblique on 19 eyes.
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. Superior oblique overaction in patients with true browns. Superior oblique overaction in patients with true browns syndrome. Materials and methods this was a prospective study conducted at a tertiary care hospital in. Effect of combining inferior oblique muscle weakening. The superior rectus, inferior rectus, superior oblique, and inferior oblique muscles affect the vertical movement of the eyes. 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. It passes below the inferior rectus muscle before inserting into. Inferior oblique zmyotomy for hypertropia correction in. Inferior oblique overaction iooa can be primary or secondary, isolated or combined to other types of horizontal deviation, mostly with esotropias. Overaction of the inferior oblique muscle is termed primary when it is not associated with superior oblique muscle paralysis. Patients without cn iv showed more frequent head tilt 96% vs. Primary inferior oblique muscle overaction has the characteristics of a muscle that primarily has decreased elasticity. Inferior oblique belly transposition for small angle.
Comparison of inferior oblique muscle weakening by. Dissociated vertical deviation and inferior oblique overaction. Usually severe 3 to 4 limitation of elevation on abduction. Normal overaction of inferior oblique muscles jama. 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. Almost 40 years ago scobee 2 referred to the normal overaction of. Our servers in the cloud will handle the pdf creation for you once you have combined your files. To investigate the surgical outcomes of inferior oblique muscle z myotomy in patients with inferior oblique overaction iooa. There is marked abduction and hypertropia of the adducting eye when elevation is carried out in side gaze, but there is no hypertropia.
She had a best corrected visual acuity of 66 in both eyes with 1. Pdf hangback recession of inferior oblique muscle in v. Inferior oblique muscle definition of inferior oblique. Anterior transposition and myectomy were compared to evaluate the surgical results in inferior oblique overaction. Surgical weakening of the io muscle can be performed, either unilaterally or bilaterally, to treat primary or secondary inferior oblique overaction. 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. Vpattern strabismus with pseudooveraction of the inferior oblique muscles is a. Disease bioinformatics research of inferior oblique overaction has been linked to strabismus, dysplasia, intraepithelial neoplasia, esotropia, dissociated vertical deviation. This syndrome is defined by y pattern strabismus with exotropia in upgaze. Imaging of cranial nerves iii, iv, vi in congenital.
We demonstrate the correlation between the traction test and clinically graded io overaction. Clinical manifestations, diagnosis, and surgery of. Relationship of inferior oblique overaction to muscle bulk. The exact cause is unknown, although it is logical to assume it is from faulty innervation of eye muscles. Inferior oblique muscle surgery is so successful because oaio is a condition that disappears with maturity. Sensorimotor and orbital anatomical mechanisms have been invoked to explain primary oblique muscle overaction. Underacting inferior oblique muscle following myectomy or. Anterior transposition, disinsertion, inferior oblique muscle overaction, myectomy introduction excessive elevation of the eyeball in intended adduction is a consequence of inferior oblique muscle over action iooa, which is a common disorder of ocular motility 1 and is reported in 70% of patients with esotropia and 30% of. Primary oblique muscle overaction is a common ocular motility disorder characterized by vertical incomitance of the eyes in lateral gaze.
Eye muscles work together with other eye muscles, of the same eye and the opposite eye, to. Review ticle imaging of cranial nerves iii, iv, vi in. All patients with hypertropia undergoing inferior oblique zmyotomy during a 4 year period between june 2011 and june 2015 were included in the study. Surgery on the inferior oblique muscle springerlink. Here is a schematic of a left eye, showing how its extraocular muscles insert into the eye. Inferior oblique muscle an overview sciencedirect topics. Historically, inferior oblique surgery was considered extremely difficult and was fraught with complications such as fat adherence, ciliary nerve damage with pupillary dilatation, and intraoperative hemorrhage. This retrospective study was performed on patients with primary and secondary iooa who underwent three. Backgroundaimsamong the various weakening techniques of inferior oblique muscle overaction, the most commonly used techniques include myectomy, recession, and anterior transposition. We wanted to examine the effect of graded recession and anteriorization of the inferior oblique. Adherence syndrome after weakening procedure of inferior oblique muscle. These muscles may be either paretic, restrictive fibrosis or overactive effect of the muscles. To merge pdfs or just to add a page to a pdf you usually have to buy expensive software. Six eyes in which recurrent inferior oblique muscle overaction developed after an.
Postoperative outcomes in terms of residual inferior oblique overaction were compared. How to merge pdfs and combine pdf files adobe acrobat dc. Expression of myod, insulin like growth factor binding. Increased frequency of activated satellite cells in. Unilateral inferior oblique muscle myectomy and recession. Inferior oblique overaction may be primary and of unknown etiology, or secondary to a congenital superior oblique palsy, as covered in chapter 19.
Unilateral primary inferior oblique overaction is unusual and many cases may actually represent very asymmetric bilateral inferior oblique overaction. Frequency of the superior rectus muscle overaction. Anterior transposition of the inferior oblique muscle for dissociated vertical deviation john p. Pdf postulating a role for connective tissue elements in. Surgical management of primary inferior oblique muscle.
Postulating a role for connective tissue elements in inferior oblique muscle overaction an american ophthalmological society thesis by david stager jr md, linda k. Jan 28, 2015 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. Oblique muscle pseudooveraction go to academy store learn more and purchase. Inferior oblique muscle overaction how is inferior oblique muscle overaction abbreviated. 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. Because true hyperinnervation is not usually present, this phenomenon is better termed elevation in adduction. Pdf uses of the inferior oblique muscle in strabismus. A case of v pattern exotropia with inferior oblique overaction in a young patient. The inferior oblique muscle or obliquus oculi inferior is a thin, narrow muscle placed near the anterior margin of the floor of the orbit. Commentary on the outcomes of inferior oblique muscle. Strabismus is an oculomotor disorder in which there. The neurofibrovascular bundle of the inferior oblique muscle as the. A valid indication and the effect of bilateral inferior oblique.
The effect of graded recession and anteriorization on. Improved surgical treatment of vpattern strabismus with pseudo. 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. Browns syndrome from an inferior oblique palsy, but which also alerts the examiner to the presence of an inferior rectus. Anterior transposition of the inferior oblique muscle for. Excessive elevation of the eyeball in intended adduction is a consequence of inferior oblique muscle over action iooa, which is a common disorder of ocular motility and is reported in 70% of patients with esotropia and 30% of patients with exotropia. If the inferior oblique muscle has only been partially weakened the vertical squint and in particular the tendency of the eye to drift upwards when looking to the opposite side, can persist. More recently, however, the management of inferior oblique overaction has improved substantially. It is difficult to diagnose before surgery, and weakening the overactive ectopic inferior oblique was required for better prognosis if this condition was confirmed during surgery. Backgroundaims among the various weakening techniques of inferior oblique muscle overaction, the most commonly used techniques include myectomy, recession, and anterior transposition. Disease bioinformatics research of superior oblique overaction has been linked to strabismus, exotropia, esotropia, ocular motility disorders, brown tendon sheath syndrome.
Merge pdf files combine pdfs in the order you want with. The eye is elevated in adduction, both horizontally and in upgaze fig 101. Right incyclotorsion was positive compared to the left side. This free and easy to use online tool allows to combine multiple pdf or images files into a single pdf document without having to install any software. The main measures were the type of inferior oblique overaction iooa, pre and. They report on a retrospective study of the treatment for inferior oblique overaction iooa performed over a 10year period on 122 eyes utilizing three different surgical techniques to weaken the inferior oblique muscle. Surgical weakening of iooa means several techniques like. Ioe is a rare congenital dysplasia variation of the extraocular muscle, which could appear as inferior oblique overaction. The ocular torsion produced by primary oblique muscle overaction also initiates a cascade of secondary mechanical events, including rotational displacement of the rectus muscle insertions, oblique muscle length adaptation, and mechanical tightening of the oblique muscles.
It is called secondary when it accompanies paresis or palsy of the inferior oblique muscles antagonist superior oblique muscle or yoke superior rectus muscle. Pseudo inferior oblique overaction, clinical findings. Occasionally further surgery to the inferior oblique muscle is required to correct this. The effect of inferior oblique muscle z myotomy in patients. 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. Dissociated vertical deviation dvd is an eye condition which occurs in association with a squint, typically infantile esotropia. The inferior oblique is an extraocular muscle, and is attached to the maxillary bone and the posterior, inferior, lateral surface of the eye. 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.
Surgery of the inferior oblique muscle the treatment of superior oblique palsies is one of the more complicated problems in strabismology and it is more prudent to refer such a patient to a strabologist for management if it is possible. The key to understanding apparent extraocular muscle overaction is to differentiate between a muscle that has decreased elasticity and one that is strengthened. The records of 94 patients who had been treated due to primary inferior oblique muscle overaction were retrospectively analyzed. Select multiple pdf files and merge them in seconds. The actions of the inferior oblique are responsible for moving the visual gaze up and out. Recession vs myotomycomparative analysis of two surgical. Inferior oblique overaction that is secondary to ipsilateral so palsy represents a somewhat different scenario. Oblique muscle pseudo overaction go to academy store learn more and purchase. The study of inferior oblique overaction has been mentioned in research publications which can be found using our bioinformatics tool below.
The most common indications for surgery on the inferior oblique muscle include superior oblique palsy, primary inferior oblique overaction, vpattern horizontal strabismus with inferior oblique overaction, and dissociated vertical deviation associated with inferior oblique overaction. The study of superior oblique overaction has been mentioned in research publications which can be found using our bioinformatics tool below. Inferior oblique muscle surgery pediatric ophthalmology pa. Inferior oblique io muscle overaction may occur as a primary condition or develop secondarily to specific events such as superior oblique so palsy. To evaluate and quantify the effect of inferior oblique muscle weakening on horizontal deviations. To further define the clinical features of patients with inferior oblique muscle overaction iooa and evaluate the. May 01, 2009 journal of pediatric ophthalmology and strabismus nelson. Hangback recession of inferior oblique muscle in vpattern strabismus with inferior oblique overaction. Comparison of inferior oblique muscle weakening by anterior transposition or myectomy. Horizontal muscle transposition or oblique muscle weakening for the.
A left inferior oblique overaction results in a left hypertropia in primary position, which increases in right gaze. Here we describe the outcomes of inferior oblique zmyotomy for the management hypertropia resulting from inferior oblique overaction, previous surgery or superior oblique palsy. Inferior oblique muscle weakening procedures springerlink. Quantitative assessment of inferior oblique muscle overaction. Pdf anteriorization of inferior oblique muscle in management of. Jun 19, 2018 brown syndrome inelastic superior oblique muscletendon complex primary superior oblique overaction. In this situation, there is still shortening of the muscle due to the excyclorotation that occurs in so palsy, and consequently there is loss of the io elasticity.
To compare the localization and density of collagens i, iv, vi, and elastin, the major protein components of connective. Europe pmc is an archive of life sciences journal literature. The main measures were the type of inferior oblique overaction iooa, pre and postoperative amount of iooa, and horizontal deviations in. Overaction of the inferior oblique muscle is a commonly observed component of childhood strabismus, particularly infantile esotropia and exotropia. Hypertropia may be either congenital or acquired, and misalignment is due to imbalance in extraocular muscle function. List the complications of treatment, their prevention and management.
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