Anomalous Head Posture Research Articles

Highly dosed Anderson and Kestenbaum operations for anomalous head posture due to nystagmus

HintergrundDie Korrektur einer Kopfzwangshaltung (KZH) bei infantilem Nystagmussyndrom (INS) erfolgt mit der Kestenbaum-Operation (KO) in Form der beidseitigen Rücklagerung der in KZH aktiven Agonisten und Verkürzung ihrer Antagonisten oder mit der Anderson-Operation (AO) durch die alleinige Rücklagerung der Agonisten.Ziel der ArbeitVergleich der Ergebnisse hoch dosierter AO und KO bei ähnlicher KZH.Patienten und MethodenIn unterschiedlichen Zeiträumen (2013 bis 2019 bzw. 2003 bis 2013) kam ausschließlich die AO bzw. die KO zur Anwendung. Eine hoch dosierte AO erhielten in einer konsekutiven Fallserie 33 Orthotrope mit INS und KZH, eine KO erhielten 19 Patienten. Die Mediane und Streubreiten (min–max) in den Gruppen AO/KO betrugen: Alter bei OP 7 (4–44) Jahre/6 (4–27) Jahre; KZH 32,5°(20–45)/30°(17–40); Operationsstrecke pro Auge AO 13 (10–16) mm (Standarddosis), KO 10 (6–12) mm + 10 (6–12) mm (Mittel 0,60 mm/°KZH).ErgebnisseDie KZH betrug nach ca. 3 Monaten 10°(−3–20)/10°(−7–20), bei der Spätkontrolle (8 bis 153 Monate) 10°(0–20)/10°(−27–30). Sie war bei der letzten Kontrolle um 67 % (20–100)/64 % (14–100) verringert. Eine Restdrehung ≤15° fand sich in 79/81 % der Fälle (91 % nach AO ≥13 mm; n = 23), ein Rest ≤10° in 55/57 %, (65 % nach AO ≥13 mm). Die Ad‑/Abduktionsfähigkeit der rückgelagerten Muskeln betrug nach AO 30°/30° (10–37/15–45), nach KO 32°/30° (10–40/12–45). Eine assoziierte Kopfneigung wurde durch den Eingriff nicht verbessert. Der mittlere Anstieg des binokularen Visus betrug jeweils <1 Zeile, in der Gruppe AO 1 Zeile bei Kindern ≤6 Jahre, kein Anstieg in der Altersklasse >6 Jahre.SchlussfolgerungAO und KO waren bei der verwendeten Dosierung wirkungsgleich. Die geringere Invasivität der AO spricht für deren Anwendung als Ersteingriff.

Reoperation in esotropic Duane retraction syndrome: Long-term motor outcome of superior rectus transposition.

The aim was to evaluate the long-term motor outcome of superior rectus transposition procedure in patients affected by unilateral esotropic Duane retraction syndrome with residual esotropia and anomalous head position. A retrospective analysis of medical records of patients affected by esotropic Duane retraction syndrome who underwent superior rectus transposition procedure as reoperation for residual esotropia and/or residual anomalous head position. Amount of deviation, anomalous head position, duction limitation, globe retraction, presence of upshoot/downshoot, and vertical deviation were analyzed before and after superior rectus transposition procedure. Twenty patients were selected. All patients underwent unilateral medial rectus recession or bilateral medial rectus recession, for unilateral esotropic Duane retraction syndrome at least 2 years before superior rectus transposition reoperation. Mean age at surgery (superior rectus transposition) was 12 ± 6.8 years, and the follow-up period was 2.7 ± 0.6. Mean deviations at distance and near before surgery were 19.5 ± 5.7 and 15.2 ± 6.8, respectively. Two patients showed upshoot. Head turn was 11.4 ± 5.1°; abduction limitation was -2.6 ± 0.9. After superior rectus transposition, all patients showed an improvement of esotropia at distance and near (8.1 ± 5.7 and 5.1 ± 5.6, respectively; p < 0.05), anomalous head position (5.6 ± 3.9°; p < 0.05), and abduction limitation (-2.3 ± 0.8; p < 0.05). No statistically significant changes occurred in globe retraction. No adduction limitation, vertical deviation, and upshoot/downshoot were present after superior rectus transposition procedure. Results were stable during follow-up. Superior rectus transposition procedure is an effective procedure in esotropic Duane retraction syndrome patients who previously undergone unilateral/bilateral medial rectus recession, with residual esotropia and anomalous head position. It allows improvement of esotropia, head turn, and partial recovery of abduction in a significant percentage of patients (30%) with no vertical complications.

Uncovering homonymous visual field defects in candidates for pediatric epilepsy surgery.

Perimetry in children can be challenging due to low cooperation and short attention span. Especially during the pre-surgical work-up of children with pharmaco-refractory epilepsies, however, diagnosing homonymous visual field defects (HVFDs) can be crucial for planning surgical strategies. Here, we evaluated "campimetry" for visual field testing in children. Furthermore, we analyzed strabismus and anomalous head posture as clinical signs for HVFDs. Campimetry and a standard orthoptic examination were performed in 18 patients (age range: 3y 2m-18y) who underwent epilepsy surgeries in our center during the study period, and in 11 additional patients (age range: 2y 10m-22y 10m) with suspected or confirmed HVFDs. In 16/18 patients of our unselected surgery cohort, pre- and postoperative campimetry was successfully completed. Of these, only 7/16 patients had intact visual fields pre- and postoperatively, while 5/16 patients already showed preoperative HVFDs and 4/16 patients suffered newly acquired HVFDs as calculated consequences of the surgery. Regarding clinical signs, strabismus (mostly esotropia) and anomalous head posture were specific indicators of HVFDs (strabismus: 6/12 with HVFDs vs 1/18 without; anomalous head posture: 8/12 with HVFDs vs 0/18 without). For perimetry in children with limited cooperation, we suggest campimetry as it allows early detection and fast delineation of HVFDs. This is particularly important in pediatric epilepsy surgery patients, who display a surprisingly high proportion of HVFDs (9/16). Both, strabismus and anomalous head posture can indicate such HVFDs. Therefore, clinicians should pay attention to these clinical signs, especially in the context of epilepsy surgery.

Clinical evaluation of graded Anderson’s procedure in idiopathic infantile nystagmus

ABSTRACTAim: To study the efficacy of graded, bilateral, single, horizontal yoked rectus muscle recession for correction of anomalous head posture (AHP) in idiopathic infantile nystagmus (IIN). We hypothesize that the above procedure would sufficiently correct AHP in IIN.Methods: Case records of patients who presented with IIN and AHP due to eccentric null position were included in a retrospective study following IRB approval. Best-corrected visual acuity (binocular Snellen’s acuity for distance, in both null position and primary position), anterior segment evaluation using slit lamp biomicroscopy, fundus examination, ocular motility examination and stereopsis (using TNO for adults and older children, Titmus fly test for younger children) were recorded. In all cases recession of the yoke muscles was performed with a gradation of recession, depending on the initial head turn as elaborated in Table 1. AHP was recorded before surgery and 1 and 3 months after surgery. Visual acuity and stereopsis before and after surgery were recorded.Results: Mean AHP improved from 22.5 ± 6.12 degrees of head turn preoperatively to 7.58 ± 3.62 degrees at 1-month postoperative visit (p < .001). The mean binocular visual acuity improved from 0.47 ± 0.15 preoperatively to 0.25 ± 0.17 after surgery (p < .001).Conclusion: Graded yoke muscle recession based on the initial head turn was found to be successful in correcting moderate AHP in patients with IIN. This procedure leaves behind two recti muscles for further surgical intervention in cases with residual AHP.

High-dose Anderson operation for nystagmus-related anomalous head turn.

To evaluate the effectiveness of a high-dose Anderson procedure (AP) to correct infantile nystagmus-related anomalous head turn (HT). Twenty-nine consecutive orthotropes with infantile nystagmus with and without associated sensory defect received high-dose AP. HT was measured while the patient tried to read letters at best-corrected visual acuity (BCVA) level at 5m and 0.3m. BCVA, binocular vision (BV), and alignment (prism and cover test) were measured. High-dose AP with recessions of 9-16mm was performed. All measures were taken before and 3-6 and ≥ 8months post surgery. Success was defined by postoperative HT ≤ 10°/HT ≤ 15°. Medians and ranges (minimum-maximum) were:. Age at surgery was7years (4-44). HT at 5m and HT at 0.3m were35° (20-40) and 20° (0-35), respectively. After 4months (3-6), HT was 10° (- 3-20) and 5° (- 5-20); success rates were 74%/96% and 83%/96%. After 15months (8-45), HT was 12° (0-20) and 6° (0-15); success rates were 46%/75% and 92%/100%; residual HT > 15° occurred in 5/9 cases with recessions < 13mm and 1/15 cases with recessions ≥ 13mm. With recessions ≥ 13mm, 60% (95% confidence intervals (C.I.), 33-83%) achieved HT ≤ 10° and 93% (95% C.I. 66-99%) achievedHT ≤ 15°. Overcorrection did not occur. Anomalous head posture components in vertical and frontal planes did not improve. Residual motility was 30° (10-45). The mean BCVA improved by only 0.037 logMAR (p = 0.06). BV and ocular alignment were constant, except in 2 patients whose exophoria decompensated. Kestenbaum surgery is a common procedure to correct infantile nystagmus-related HT. Anderson surgery is confined to bilateral yoke muscle recession; hence, less invasive but nevertheless comparably effective, high dosage is provided.

Etiology and Age Modifies Subjective Visual Function After Cerebral Hemispherectomy.

Cerebral hemispherectomy is typically used to treat patients with pharmacoresistant epilepsy. Visual-related outcomes are relatively unstudied in this population, aside from the knowledge that patients develop a complete homonymous hemianopia contralateral to the side of the hemispherectomy. The purpose of this study was to determine and characterize parent-reported functional visual, oculomotor, and postural changes in a large population of patients following cerebral hemispherectomy. An online survey was sent to parents of children who had undergone hemispherectomy for seizure control. Families were recruited by the Brain Recovery Project: Childhood Epilepsy Surgery Foundation. Parent-reported subjective visual function was assessed by the presence of peripheral field defects, ocular misalignment and anomalous head posture. A total of 196 (12.5%) participants responded. Postoperative follow-up was 92±78 months (range: 1-382). Ninety-three percent of parents reported the child had difficulties with peripheral vision. Torticollis was present postoperatively in 122 (62%) patients. Strabismus was noted in 93 (49%). Fifty-five (59%) of the strabismus patients demonstrated exotropia with the majority of exotropia patients demonstrating the exo-deviated eye in the direction contralateral to the hemispherectomy (74.5%). Both torticollis and strabismus were most frequently seen immediately after surgery. Sixty-six patients (34%) underwent strabismus treatment. Patients with younger age of seizure onset, younger age of surgery, and certain epilepsy etiologies (hemimegencephaly, Sturge-Weber syndrome) were more likely to develop strabismus and torticollis. Torticollis and strabismus are common after hemispherectomy and appear to be influenced by etiology and age at surgery. Preoperative discussion with parents and patients regarding those compensatory mechanisms is recommended, and postoperative ophthalmologic assessments are also encouraged.

Botulinum toxin-A injection in esotropic Duane syndrome patients up to 2 years of age

To evaluate the role of botulinum toxin-A (BTX) injection as the primary treatment for patients with esotropic Duane retraction syndrome ≤2 years of age. The medical records of patients with esotropic Duane syndrome who underwent unilateral or bilateral BTX injection to the medial rectus muscle at or before 2 years of age were reviewed retrospectively. The following data were extracted from the record: laterality, age at the time of injection, primary position deviation, duction deficit, anomalous head posture, globe retraction before and after injection, further surgeries, and complications. Success was defined as permanent resolution of esotropia and head turn in primary position at final follow-up. A total of 15 patients (14 unilateral, 1 bilateral) were included. Before BTX injection the mean primary esotropia at near with full cycloplegic refraction was 29.3Δ ± 14.4Δ; the mean head turn, 23° ± 11°. Mean duration of follow-up was 37±29months (range, 7-96months). Orthotropia and resolution of head turn was achieved in 7 patients (46.7%). In subgroup analysis, success rate gradually decreased from 100% in patients ≤7months of age to 33.3% in patients 8-12months of age, and 20% in patients >12months of age. Seven patients (46.7%) required surgery (medial rectus recession and/or superior rectus transposition) because of residual head turn and esodeviation following BTX. In this patient cohort, orthotropia in primary position and correction of head turn were achieved with a single BTX injection in about half of the patients ≤2 years of age and all patients ≤7months of age. BTX injection early in infancy can obviate the need for surgery in esotropic Duane syndrome.

Clinical and electrophysiological results of eye muscle surgery in 17 patients with downbeat nystagmus.

Purpose:To test the hypothesis that eye muscle surgery in treatment of patients with acquired downbeat nystagmus results in improvement measures of visual and ocular motor function.Methods:This is a prospective, interventional case series analysis of clinical and electrophyisological data before and after eye muscle surgery in 17 patients with acquired downbeat nystagmus who did not respond to medical treatments. Outcome measures included: 1) routine demography and clinical characteristics, 2) subjective oscillopsia (SO), 3) binocular best-corrected visual acuity in the null position (BVA), 3) primary position strabismic deviation (SD), 5) anomalous head posture (AHP), 6) contrast sensitivity function (CS), and 7) nystagmus slow phase velocity (SPV). All patients were followed at least 12 months. Parametric and non-parametric statistical analysis of outcome measure data above pre- and post-treatment were perfomed using standard software on grouped data using computerized software.Results:Patients’ age ranged from 5 to 85 years (average 27 years). About 59% were male. Follow up ranged from 1–10 years (average 2.0 years). Around 70% had an associated central nervous systemic diagnosis, 100% had an AHP, oscillopsia and decreased CS, 53% had other eye disease, and 59% had strabismus. There were no complications from surgery. There were signficant post-treatment improvements in mean/median group BVA, SO, SD, AHP, CS, and SPV.Conclusion:This study supports the hypothesis that eye muscle surgery as treatments for patients with acquired downbeat nystagmus can result in improvements in multiple aspects of ocular motor and visual functions.

Face turns in Type 1 Duane's retraction syndrome – Right? Left? or none?

Purpose: The purpose of this study is to create awareness about the face turns in Type 1 Duane's retraction syndrome (DRS). Subjects and Methods: This was a retrospective analysis of 27 cases of Type 1 DRS seen in a teaching hospital. A complete strabismus workup with emphasis on deviation in primary gaze and presence and direction of anomalous head posture was done. Results: Of 27 patients, 9 patients (33.33%) had esotropia, 8 (29.63%) had exotropia, whereas 10 (37.03%) were orthotropic in primary gaze; 17 (62.96%) had a face turn, 9 (33.33%) patients had a face turn toward the affected side, 8 (29.63%) toward the sound side, while 10 (37.03%) did not have a face turn. Conclusions: It is important to be aware that patients with Type 1 DRS may have an associated face turn; the direction of which is variable depending on the deviation present in the primary position. Awareness of this interesting observation of the variations in face turn prevents a misdiagnosis of sixth nerve palsy which has more serious clinical implications.

Duane retraction syndrome: Clinical presentation and management strategy

Duane retraction syndrome (DRS) is a special strabismus with variable presentation. It has been best classified by Huber based on electromyography in 1974 into three types. Huber type I is the most common form of DRS with an earlier presentation and also has satisfactory surgical outcomes. Huber type II is the least common presentation. Ahluwalia et al. in 1988 have further divided it into subgroups A, B, and C based on the alignment in primary position, indicating esotropia, exotropia, and orthophoria. Type I has esotropia, type II has exotropia, and type III has esotropia and exotropia equally common. DRS can be associated with other ocular abnormalities and systemic issues when present in syndromes. Hence, these patients need a more detailed evaluation. Management strategy aims at alignment in primary position, correcting anomalous head posture, improving palpebral fissure size, and alleviating upshoots and downshoots. It is challenging to address these patients and they need to be counseled before surgery regarding the outcome that is expected of the surgery.

Rectus muscle plication in the treatment of anomalous head position associated with nystagmus

Rectus muscle plication in the treatment of anomalous head position associated with nystagmus

Outcomes of esotropia surgery in Saudi Arabia: An audit from a single center

PurposeTo monitor the outcomes of surgical correction of esotropia in order to improve preoperative counselling for patients and their families. MethodsA retrospective review audit of the medical charts at King Fahad Medical City. All patients treated surgically to correct esotropia, from January 2007 to December 2013. All operated cases were included regardless of age and esotropia etiology. The study used a goal-determined metric to assess the outcomes of strabismus surgery > 6 months post-operatively, and on last follow-up. The risk factors for poor surgical outcomes were identified using a Pareto chart. ResultsA total of 99 cases with sufficient documentation to determine the surgical goal were included in the analysis. The goal was to improve eye contact (cosmetic correction) in 77.8% cases, to establish binocularity in 15.2% cases, to resolve diplopia for 4% cases, and to improve anomalous head posture for 3%. The overall outcome was excellent for 70.7% at the first follow-up and for 57.6% at the final visit. Simultaneous vertical muscle surgery and/or superior oblique muscle palsy were risk factors for poor outcome (odds ratio 3.15, 95% CI 1.11–8.99). ConclusionsExcellent outcome of esotropia surgery in this study is comparable to outcomes reported internationally using the goal determined metrics. Quality improvement processes like the Pareto chart are simple to use and helpful for determining the risk factors associated with poor surgical outcomes after esotropia correction from different etiology.

Visual acuity in eccentric gaze in patients with infantile nystagmus syndrome (INS)

Patients with INS often have a null-zone where the nystagmus intensity is at its minimum, resulting in an anomalous head posture to achieve better visual function (VF). Traditional measures of VF in primary gaze may not reflect the deficit imposed on the visual system, thus an improved method would be to measure vision as a function of gaze position. The purpose of this study was to assess the test/re-test of high-contrast (HCVA) and low-contrast (LCVA) visual acuity across horizontal gaze (HG) to determine if gaze dependent visual acuity (GDVA) measures are reliable.

Lateral rectus muscle recession for intermittent exotropia with anomalous head position in type 1 Duane’s retraction syndrome

We questioned how to treat for intermittent exotropia in type 1 Duane's retraction syndrome (DRS). To avoid secondary abduction deficit and late overcorrection on the affected eye following ipsilateral lateral rectus (LR) recession, we performed less correction of the lateral rectus (LR) recession to correct exodeviation and anomalous head position (AHP). We report the surgical outcomes of LR recession in patients with unilateral type 1 DRS. Four patients who underwent less correction of LR recession in the affected eye to correct intermittent exotropia and AHP to the contralateral side in type 1 DRS were enrolled. Data on preoperative and postoperative angle of exodeviation, degree of AHP, ocular motility, global retraction, palpebral fissure change, and complications were retrospectively obtained. Success was defined as postoperative deviation within 8 prism diopters (PD) and AHP < 5°. The preoperative angles of exodeviation and AHP were significantly improved after LR recession. The median grade of abduction limitation was improved from - 1.3 to - 0.8 postoperatively. Final median value of deviation was orthotropia in the primary position of the eye with the normal motility. All patients had successful outcomes without overcorrection or further abduction limitation in DRS eyes. Less correction of ipsilateral LR recession may be useful for correcting intermittent exotropia and AHP in patients with type 1 DRS.

Inferior Rectus Transposition: A Novel Procedure for Abducens Palsy

Superior rectus transposition has been popularized for the treatment of abduction deficiencies. Potential complications include induced vertical deviation and torsion. A new procedure, the inferior rectus transposition (IRT), may be similarly beneficial for patients at risk for postoperative vertical deviation or incyclotropia. The purpose of this study is to describe the outcomes of patients undergoing IRT. Prospective, interventional case series. Five patients in an academic pediatric ophthalmology and strabismus practice with a complete lateral rectus palsy who underwent IRT were studied. Changes in anomalous head posture, ocular rotations, ocular alignment, and torsion preoperatively to postoperatively were compared. The patients ranged in age from 19-89 years. There was a significant correction in the angle of esotropia (ET) from 39±17Δ (14-55Δ) to 12 ± 9.8Δ (0-22Δ) postoperatively (P= .02). Two of 5 patients had preoperative hypertropia of the affected eye (1.4 ± 2.2Δ; range, 2-5Δ). One of those had no vertical deviation postoperatively and 1 patient resulted in 2Δ hypotropia. One patient without vertical misalignment preoperatively developed a small postoperative vertical deviation. Torticollis significantly improved from 31.4 ± 11.6° to 5 ± 5.8° (P= .004). All patients improved abduction, with a mean of-4.4 ± 0.5 preoperatively to-3.4 ± 0.9 postoperatively (P= .07). Initial postoperative follow-up in patients with abducens palsy undergoing IRT shows a significant improvement in ocular alignment and torticollis. In patients with preoperative hypertropia, IRT resulted in a downward shifting effect on the operated eye. IRT may be a beneficial procedure for patients with preoperative hypertropia or intorsion requiring transposition procedures. Future studies with larger populations and longer durations of follow-up will be required before this procedure can be recommended.

Rectus muscle plication for the treatment of anomalous head position and nystagmus

Rectus muscle plication for the treatment of anomalous head position and nystagmus

Type 4 Duane syndrome

To identify cases of synergistic divergence whose characteristics suggest that this entity is a form of Duane syndrome. The records of all patients with a Duane syndrome diagnosis, including standardized eye position photographs, from the E-Consultation program of Cybersight, Orbis International were analyzed. A total of 350 Duane syndrome cases were identified. Of these, 19 (5%) had features consistent with synergistic divergence, or type 4 Duane syndrome. Of the 19, 16 (84%) were male, 15 (79%) had palpebral fissure narrowing, all had anomalous head posture, and 18 (95%) were exotropic. Only 9 (47%) patients were reported to have undergone surgery. Synergistic divergence is a rare entity with features similar to those of Duane syndrome. We suggest that this entity be classified as type 4 Duane syndrome, because it has unique findings and an innervation pattern that differs from the other 3 recognized types.

Grisel’s syndrome, a rare cause of anomalous head posture in children: a case report

BackgroundAnomalous head posture (AHP) or torticollis is a relatively common condition in children. Torticollis is not a diagnosis, but it is a sign of underlying disease. Grisel’s syndrome (GS) is a rare condition of uncertain etiology characterized by a nontraumatic atlanto-axial subluxation (AAS), secondary to an infection in the head and neck region. It has not been considered, in ophthalmological papers, as a possible cause of AHP.Case presentationA case of AAS secondary to an otitis media is studied. The children showed neck pain, head tilt, and reduction in neck mobility. The patient had complete remission with antibiotic and anti-inflammatory therapy and muscle relaxants. Signs of GS should always be taken into account during ophthalmological examination (recent history of upper airway infections and/or head and neck surgeries associated to a new onset of sudden, painful AHP with normal ocular exam). In such cases it is necessary to require quick execution of radiological examinations (computer tomography and/or nuclear magnetic resonance), which are essential to confirm the diagnosis.ConclusionGS is a multidisciplinary disease. We underline the importance of an accurate orthoptic and ophthalmological examination. Indeed, early detection and diagnosis are fundamental to achieve proper management, avoid neurological complications and lead to a good prognosis.

Clinical Evaluation of Four-Muscle Tenotomy Surgery for Nystagmus.

To document prospectively the effect of four-muscle tenotomy surgery on visual acuity (VA) and nystagmus intensity and assess, by the use of a questionnaire, the experience of adult patients and the parents of children who have had the four-muscle tenotomy procedure for nystagmus in the absence of strabismus or an anomalous head position. The qualitative perceived benefits or lack thereof from the procedure were compared to the subjective effects on nystagmus intensity and VA. Fifteen patients diagnosed as having congenital/infantile or acquired nystagmus, including albinism or other visual sensory disorders without anomalous head positions or coexisting strabismus, were included in this study. The changes in preoperative and postoperative VA and nystagmus were evaluated based on clinical and perceptual measurements and video recordings. All 15 patients had preoperative and postoperative ophthalmological examinations. One patient had a postoperative conjunctival cyst, which was successfully removed. Fourteen patients (93%) showed clinical VA improvement in at least one eye. Fourteen patients were video recorded preoperatively and postoperatively to analyze their nystagmus intensity; case 9 was not included. Postoperatively, 10 patients (71%) showed a decrease in nystagmus intensity. Thirteen patients (87%) perceived vision improvement and 11 patients (73%) perceived a decrease in nystagmus intensity. All patients experienced either clinically improved VA or a decrease in nystagmus intensity. Fourteen patients (93%) perceived either improved VA or a decrease in nystagmus intensity. The preoperative and postoperative changes in VA (P = .002) and nystagmus intensity (P = .043) were both statistically significant. The authors have shown that four-muscle tenotomy surgery for nystagmus can improve VA and decrease nystagmus intensity. The study yielded subjective patient satisfaction, modest objective improvement in VA, and no significant complications.

Fat adherence syndrome following inferior oblique surgery: Treatment and outcomes

PurposeDescribe surgical treatment and results in a group of patients diagnosed and operated on of fat adherence syndrome following inferior oblique surgery. Patients, material and methodsRetrospective study of 6 cases diagnosed and treated of fat adherence syndrome following inferior oblique surgery. Mean age was 24.67 years (range, 5–41), 3 males, 5 unilateral and 1 bilateral. Mean vertical deviation was 16.16pd (range, 4–25). Esotropia was associated in 4 cases, diplopia in other 2, and anomalous head posture in 3. A good outcome was considered when the final deviation was less than 10pd, with mild limitation of elevation, without anomalous head posture, and a negative duction forced test. ResultsThe final vertical deviation was 6.83pd (range, 0–14). A 2–4mm inferior rectus recession was performed on 4 patients associated to an inferior oblique surgery/exploration. All patients were operated on once, except 1 case. A good outcome was achieved in 3 patients. Anomalous head posture was resolved in 2 of 3 cases. Diplopia resolved after surgery. Only one case achieved orthophoria. Mean evolution time was 34.83 months (range, 6–78). ConclusionIn the treatment of the fat adherence syndrome, an inferior rectus recession is recommended, associated to inferior oblique exploration or surgery. A good favorable outcome was only achieved in half of the cases with surgical treatment. Limitation of elevation could not be completely resolved in any of the patients.