Anterior and Nasal Transposition of the Inferior Oblique Muscle for Iatrogenic Superior Oblique Palsy | Facial Plastic Surgery | JAMA Ophthalmology | JAMA Network
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Research Letter
Oct 2011

Anterior and Nasal Transposition of the Inferior Oblique Muscle for Iatrogenic Superior Oblique Palsy

Author Affiliations

Author Affiliations: Yong Loo Lin School of Medicine, National University of Singapore (Dr Wong), Department of Ophthalmology, National University Hospital Singapore (Drs Wong, Choi, and Farzavandi), and Singapore National Eye Center (Dr Farzavandi), Singapore; and Department of Strabismology and Pediatric Ophthalmology, University of Liège, Liège, Belgium (Dr Paris).

Arch Ophthalmol. 2011;129(10):1381-1382. doi:10.1001/archophthalmol.2011.301

The reflected tendon of the superior oblique (SO) muscle lies in close proximity to the medial horn of the levator palpebrae superioris aponeurosis in the superomedial aspect of the upper eyelid, placing it at risk for inadvertent damage during surgery in that area. However, although levator resection or excision procedures are commonly performed, this complication is rarely reported.1,2 Kushner and Jethani1 reported a series of 7 patients who sustained SO tendon injury during various types of eyelid procedures, which led to SO palsy in 4 cases and Brown syndrome in 3. We describe a case of iatrogenic SO palsy following congenital ptosis surgery that, because of a large torsional component, we elected to treat with anterior and nasal transposition of the ipsilateral inferior oblique (IO) muscle instead of other conventional procedures.