SURGERY on the superior oblique, unlike other extraocular muscles, is confined to the muscle's tendonous portion, however, the small size of this tendon and its intimate relation with Tenon's capsule makes the superior oblique less accessible and difficult to expose. The purpose of this paper is to describe a safe, simple technique for visualizing the superior oblique tendon prior to engaging it on a muscle hook and also to review a technique for intrasheath tenotomy and tenectomy of the superior oblique.
All steps are shown in Fig 1 through 10. The eye is rotated downward and outward with forceps or a muscle hook. No traction sutures are used. An incision is made through conjunctiva and Tenon's capsule in the superior nasal quadrant 6 to 8 mm from the limbus. Separate incisions in conjunctiva and Tenon's capsule placed at right angles to each other may be used to facilitate wound
Parks MM, Helveston EM. Direct Visualization of the Superior Oblique Tendon. Arch Ophthalmol. 1970;84(4):491–494. doi:10.1001/archopht.1970.00990040493018
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