CLINICAL CHARACTERISTICS AND SURGICAL-MANAGEMENT OF CONGENITAL ABSENCE OF THE SUPERIOR OBLIQUE TENDON

We reviewed clinical characteristics and surgical results of nine pati ents with surgically proved congenital absence of the superior oblique tendon. The following factors indicate absence of the tendon is the s etting of Superior oblique palsy: (1) an associated horizontal deviati on, (2) amblyopia, (3) a large hypertropia in primary position, (4) Sp read of comitance, and (5) pseudo-overaction of the contralateral supe rior oblique muscle. The nine patients required a total of 19 operatio ns to correct their vertical and horizontal deviations. Surgical manag ement was based on the preoperative action of the inferior oblique mus cle, the amount of hypertropia in primary position, and intraoperative forced ductions. After their operations, eight of nine patients had i mprovement in or abatement of their symptoms, and seven of seven with preoperative head tilts had improvement of their head position.