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—Dr Fleming is correct in his observation that many children with small hypertropias of the adducting eye on up and right gaze or up and left gaze will lose these gaze-specific hypertropias as they mature. Children who have a left hypertropia in moderate right gaze and a right hypertropia in moderate left gaze will, however, almost always demonstrate persistence and progression of overaction of their inferior oblique muscles. This is why we regarded small amounts of recurrent hypertropia on up and right gaze or up and left gaze as benign, and reserved repeated surgery (extirpation of the inferior oblique muscles) for those few cases in which hypertropias returned on side gazes.I have seen several adults with neglected infantile esotropia with extremely severe primary overaction of one or both inferior oblique muscles. Also, the very moment that a copy of Dr Fleming's letter arrived in my office, I
Mims JL. 'Normal' Overaction of Inferior Oblique Muscles-Reply. Arch Ophthalmol. 1989;107(8):1113. doi:10.1001/archopht.1989.01070020179004