001: When and how to strengthen the superior oblique muscle

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Surgery to strengthen the action of the superior oblique muscle relies entirely on procedures to advance, resect, tuck, or redirect the reflected tendon. In distinction to most other procedures on the extraocular muscles, intraoperative assessment using forced ductions is usually required to determine appropriate surgical dosage, rather than a predetermined numerical value based on preoperative findings. Although the concept of a “lax tendon” has been proposed to help determine which patients may be candidates for superior oblique tendon tuck, the definition of lax or the relationship of tendon laxity to congenital onset superior oblique muscle palsy has not been unequivocally demonstrated.