The overaction of the inferior oblique muscle and associated vertical strabismus: prevalence, etiology, and diagnosis
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Abstract
Vertical strabismus, often caused by the overaction of the inferior oblique (IO) muscle, is a common disorder of the oculomotor system. It occurs in a third of all patients with strabismus, and in 70% of these cases, it coexists with esotropia. From a clinical perspective, there is no universally accepted approach for quantifying the magnitude of inferior oblique overaction (IOOA). Existing classifications are subjective and may not be entirely appropriate. Therefore, given the need to understand the severity of this anomaly, standardizing the classification of this disorder is essential. This will aid in formulating treatment strategies and predicting the outcomes of surgical intervention. The IO muscles' mechanism of action is highly complex, and it varies depending on the position of the globe during IO contraction. Beyond their role in horizontal and vertical movements, IO muscles also participate in torsional eye movements. Any disorder of the IO muscle can contribute to not only vertical strabismus but also cyclotropia, which may limit the effectiveness of strabismus treatment. To identify all the clinical signs and symptoms resulting from IOOA, practitioners should take into account the triple action characteristics of the IO muscle. Therefore, comprehensive diagnostic examinations are necessary for patients with IOOA.
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2. Nelson BA, Gunton KB, Lasker JN, Nelson LB, Drohan LA. The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2008;12(1):72-6. e1.
3. Choi DG, Chang BL. Electron microscopic study on overacting inferior oblique muscles. Korean Journal of Ophthalmology. 1992;6(2):69-75.
4. Caldeira J. Some clinical characteristics of V-pattern exotropia and surgical outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 22 consecutive patients and a comparison with V-pattern esotropia. Binocular vision & strabismus quarterly. 2004;19(3):139-50.
5. Ha S-G, Na G-H, Kim S-H. A valid indication and the effect of bilateral inferior oblique transposition on recurrent or consecutive horizontal deviation in infantile strabismus. Korean Journal of Ophthalmology. 2017;31(2):138-42.
6. Taylan Sekeroglu H, Dikmetas O, Sanac AS, Sener EC, Arslan U. Inferior oblique muscle weakening: is it possible to quantify its effects on horizontal deviations? Journal of ophthalmology. 2012;2012.
7. Wilson ME, Parks MM. Primary inferior oblique overaction in congenital esotropia, accommodative esotropia, and intermittent exotropia. Ophthalmology. 1989;96(7):950-7.
8. Duane A. Binocular movements. Archives of Ophthalmology. 1933;9(4):579-607.
9. Liesch A, Simonsz H. Up-and downshoot in adduction after monocular patching in normal volunteers. Strabismus. 1993;1(1):25-36.
10. Stager Jr D, Dao LM, Felius J. Uses of the inferior oblique muscle in strabismus surgery. Middle East African journal of ophthalmology. 2015;22(3):292.
11. Ludwig IH, Clark RA, Stager Sr DR. New strabismus surgical techniques. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2013;17(1):79-88.
12. Worth CA, Chavasse FB. Worth's Squint, Or, The Binocular Reflexes and the Treatment of Strabismus: Baillière, Tindall and Cox; 1939.
13. Berens C. The Eye and Its Diseases by 82 International Authorities: WB Saunders; 1936.
14. Scobee RG. The oculorotary muscles: Mosby St. Louis; 1952.
15. Lancaster WB, editor Factors underestimated, features overemphasized, and comments on classification. Strabismus Ophthalmic Symposium; 1950: CV Mosby, St. Louis.
16. Guibor GP. Synkinetic overaction of the inferior oblique muscle. American Journal of Ophthalmology. 1949;32(2):221-9.
17. Von Noorden GK. Binocular vision and ocular motility. Theory and management of strabismus. 1990.
18. Verhoeff F. Occlusion hypertropia. Archives of Ophthalmology. 1941;25(5):780-95.
19. White JW, Brown HW. Occurrence of vertical anomalies associated with convergent and divergent anomalies: a clinical study. Archives of Ophthalmology. 1939;21(6):999-1009.
20. Edward J. Bielschowsky's Lectures on Motor Anomalies. American Journal of Ophthalmology. 1940;23(8):934-5.
21. DAVIS WT. Paresis of right superior oblique and of left superior rectus muscle: Differential diagnosis. Archives of Ophthalmology. 1944;32(5):372-80.
22. ADLER FH. Physiologic factors in differential diagnosis of paralysis of superior rectus and superior oblique muscles. Archives of Ophthalmology. 1946;36(6):661-73.
23. Avetisov E, Alazme A, Kashchenko T, Smol'ianinova I, Mats K, Lokhtina N. Surgical treatment of strabismus with superior oblique muscle insufficiency. Vestnik Oftalmologii. 1994;110(4):12-4.
24. Sanjari MS, Shahraki K, Nekoozadeh S, Tabatabaee S-M, Shahraki K, Aghdam KA. Surgical treatments in inferior oblique muscle overaction. Journal of ophthalmic & vision research. 2014;9(3):291.
25. Popova N, Sorokina V, Gorkin A, Yugay S. Method of dosed anterior transposition of the lower oblique muscle in vertical strabismus surgery. Fyodorov Journal of Ophthalmic Surgery. 2012;1:30-4.
26. Alazme A. ANATOMIC AND TOPOGRAPHIC FEATURES OF OBLIQUE MUSCLES AND SURGICAL INTERVENTIONS ON THESE MUSCLES. VESTNIK OFTALMOLOGII. 1991(2):70-6.
27. Min B-M, Park J-H, Kim S-Y, Lee S-B. Comparison of inferior oblique muscle weakening by anterior transposition or myectomy: a prospective study of 20 cases. British journal of ophthalmology. 1999;83(2):206-8.
28. Moon K, Lee S-Y. The effect of graded recession and anteriorization on unilateral superior oblique palsy. Korean Journal of Ophthalmology. 2006;20(3):188-91.
29. Kelkar J, Kanade A, Agashe S, Kelkar A, Khandekar R. Outcomes of asymmetric primary inferior oblique muscle overaction managed by bilateral myectomy and tucking of proximal muscle end: A cohort study. Middle East African Journal of Ophthalmology. 2015;22(4):457.
30. Porter JD, Baker RS, Ragusa RJ, Brueckner JK. Extraocular muscles: basic and clinical aspects of structure and function. Survey of ophthalmology. 1995;39(6):451-84.
31. Caldeira J. V-pattern esotropia: a review; and a study of the outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 78 consecutive patients. Binocular vision & strabismus quarterly. 2003;18(1):35-48; discussion 9.
32. Rutstein RP, Daum KM. Anomalies of binocular vision: diagnosis & management: Mosby Incorporated; 1998.
33. Rødahl E, Seland J, Olofsson J, Aanderud S, Kråkenes J. Surgical treatment of endocrine ophthalmopathy. Tidsskrift for den Norske Laegeforening: Tidsskrift for Praktisk Medicin, ny Raekke. 1999;119(12):1737-42.
34. Brodie SE. Photographic calibration of the Hirschberg test. Investigative ophthalmology & visual science. 1987;28(4):736-42.
35. ESKRIDGE BJ, Wick B, Perrigin D. The Hirschberg test: a double-masked clinical evaluation. Optometry and Vision Science. 1988;65(9):745-50.
36. Nowakowska O, Broniarczyk-Loba A, Loba P. The reduction of AV patterns with oblique muscles overaction in unilateral and bilateral surgery. Klinika Oczna/Acta Ophthalmologica Polonica. 2008;110(4):361-3.
37. LANG J. The meaning of A and V pattern syndromes. International Ophthalmology Clinics. 1971;11(4):70-3.
38. Von Noorden GK, Murray E, Wong SY. Superior oblique paralysis: a review of 270 cases. Archives of Ophthalmology. 1986;104(12):1771-6.
39. Manchandia AM, Demer JL. Sensitivity of the three-step test in diagnosis of superior oblique palsy. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2014;18(6):567-71.
40. Oh H, Roh Y. Head tilting in the patients with superior oblique palsy. J Korean Ophthalmol Soc. 1994;35(35):454-9.
41. Rubin SE, Wagner RS. Ocular torticollis. Survey of ophthalmology. 1986;30(6):366-76.
42. Boricean I-D, Bărar A. Understanding ocular torticollis in children. Oftalmologia (Bucharest, Romania: 1990). 2011;55(1):10-26.
43. Adler FH. Adler S Physiology of the Eye: Clinical Application 5th Ed: Mosby; 1970.
44. Akbari MR, Khorrami-Nejad M, Kangari H, Baghban AA, Pazouki MR. Ocular abnormal head posture: A literature review. Journal of current ophthalmology. 2021;33(4):379.
45. Khorrami-Nejad M, Akbari MR, Kangari H, Akbarzadeh Baghban A, Masoomian B, Ranjbar-Pazooki M. Abnormal head posture in unilateral superior oblique palsy. Journal of binocular vision and ocular motility. 2021;71(1):16-23.
46. Dietrich D, Slack W. Scoliosis secondary to unilateral extraocular muscle paresis (ocular torticollis). Radiology. 1967;88(3):538-42.
47. Roussat B, Bourreau M, Hayot B, Besson D, Goddé-Jolly D. Benign isolated 6th nerve paralysis in children. Developmental aspects apropos of 9 new cases. Ophtalmologie: Organe de la Societe Francaise D'ophtalmologie. 1989;3(2):107-8.
48. Akbari MR, Khorrami-Nejad M, Amiri MA, Baghban AA, Khosravi B, Nourizad S. Facial asymmetry in unilateral duane retraction syndrome. Optometry and Vision Science. 2019;96(12):920-4.
49. Akbari MR, Khorrami-Nejad M, Kangari H, Baghban AA, Pazouki MR. Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy. Optometry and Vision Science. 2021;98(11):1248-54.
50. PHILLIPS PH, HUNTER DG. EVALUATION OF OCULAR TORSION AND PRINCIPLES. Clinical strabismus management: Principles and surgical techniques. 1999:52.
51. Parks MM. Isolated cyclovertical muscle palsy. AMA archives of ophthalmology. 1958;60(6):1027-35.
52. Sharma P, Prasad K, Khokhar S. Cyclofusion in normal and superior oblique palsy subjects. SLACK Incorporated Thorofare, NJ; 1999. p. 264-70.
53. Bixenman WW, Von Noorden GK. Apparent foveal displacement in normal subjects and in cyclotropia. Ophthalmology. 1982;89(1):58-62.
54. Harada M. Surgical correction of cyclotropia. Jpn J Ophthalmol. 1964;8:88-96.
55. Troia RN, Nelson LB, Calhoun JH, Harley RD. Surgical correction of excyclotropia. American Orthoptic Journal. 1985;35(1):63-7.
56. Morton GV, Lucchese N, Kushner BJ. The role of funduscopy and fundus photography in strabismus diagnosis. Ophthalmology. 1983;90(10):1186-91.
2. Nelson BA, Gunton KB, Lasker JN, Nelson LB, Drohan LA. The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2008;12(1):72-6. e1.
3. Choi DG, Chang BL. Electron microscopic study on overacting inferior oblique muscles. Korean Journal of Ophthalmology. 1992;6(2):69-75.
4. Caldeira J. Some clinical characteristics of V-pattern exotropia and surgical outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 22 consecutive patients and a comparison with V-pattern esotropia. Binocular vision & strabismus quarterly. 2004;19(3):139-50.
5. Ha S-G, Na G-H, Kim S-H. A valid indication and the effect of bilateral inferior oblique transposition on recurrent or consecutive horizontal deviation in infantile strabismus. Korean Journal of Ophthalmology. 2017;31(2):138-42.
6. Taylan Sekeroglu H, Dikmetas O, Sanac AS, Sener EC, Arslan U. Inferior oblique muscle weakening: is it possible to quantify its effects on horizontal deviations? Journal of ophthalmology. 2012;2012.
7. Wilson ME, Parks MM. Primary inferior oblique overaction in congenital esotropia, accommodative esotropia, and intermittent exotropia. Ophthalmology. 1989;96(7):950-7.
8. Duane A. Binocular movements. Archives of Ophthalmology. 1933;9(4):579-607.
9. Liesch A, Simonsz H. Up-and downshoot in adduction after monocular patching in normal volunteers. Strabismus. 1993;1(1):25-36.
10. Stager Jr D, Dao LM, Felius J. Uses of the inferior oblique muscle in strabismus surgery. Middle East African journal of ophthalmology. 2015;22(3):292.
11. Ludwig IH, Clark RA, Stager Sr DR. New strabismus surgical techniques. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2013;17(1):79-88.
12. Worth CA, Chavasse FB. Worth's Squint, Or, The Binocular Reflexes and the Treatment of Strabismus: Baillière, Tindall and Cox; 1939.
13. Berens C. The Eye and Its Diseases by 82 International Authorities: WB Saunders; 1936.
14. Scobee RG. The oculorotary muscles: Mosby St. Louis; 1952.
15. Lancaster WB, editor Factors underestimated, features overemphasized, and comments on classification. Strabismus Ophthalmic Symposium; 1950: CV Mosby, St. Louis.
16. Guibor GP. Synkinetic overaction of the inferior oblique muscle. American Journal of Ophthalmology. 1949;32(2):221-9.
17. Von Noorden GK. Binocular vision and ocular motility. Theory and management of strabismus. 1990.
18. Verhoeff F. Occlusion hypertropia. Archives of Ophthalmology. 1941;25(5):780-95.
19. White JW, Brown HW. Occurrence of vertical anomalies associated with convergent and divergent anomalies: a clinical study. Archives of Ophthalmology. 1939;21(6):999-1009.
20. Edward J. Bielschowsky's Lectures on Motor Anomalies. American Journal of Ophthalmology. 1940;23(8):934-5.
21. DAVIS WT. Paresis of right superior oblique and of left superior rectus muscle: Differential diagnosis. Archives of Ophthalmology. 1944;32(5):372-80.
22. ADLER FH. Physiologic factors in differential diagnosis of paralysis of superior rectus and superior oblique muscles. Archives of Ophthalmology. 1946;36(6):661-73.
23. Avetisov E, Alazme A, Kashchenko T, Smol'ianinova I, Mats K, Lokhtina N. Surgical treatment of strabismus with superior oblique muscle insufficiency. Vestnik Oftalmologii. 1994;110(4):12-4.
24. Sanjari MS, Shahraki K, Nekoozadeh S, Tabatabaee S-M, Shahraki K, Aghdam KA. Surgical treatments in inferior oblique muscle overaction. Journal of ophthalmic & vision research. 2014;9(3):291.
25. Popova N, Sorokina V, Gorkin A, Yugay S. Method of dosed anterior transposition of the lower oblique muscle in vertical strabismus surgery. Fyodorov Journal of Ophthalmic Surgery. 2012;1:30-4.
26. Alazme A. ANATOMIC AND TOPOGRAPHIC FEATURES OF OBLIQUE MUSCLES AND SURGICAL INTERVENTIONS ON THESE MUSCLES. VESTNIK OFTALMOLOGII. 1991(2):70-6.
27. Min B-M, Park J-H, Kim S-Y, Lee S-B. Comparison of inferior oblique muscle weakening by anterior transposition or myectomy: a prospective study of 20 cases. British journal of ophthalmology. 1999;83(2):206-8.
28. Moon K, Lee S-Y. The effect of graded recession and anteriorization on unilateral superior oblique palsy. Korean Journal of Ophthalmology. 2006;20(3):188-91.
29. Kelkar J, Kanade A, Agashe S, Kelkar A, Khandekar R. Outcomes of asymmetric primary inferior oblique muscle overaction managed by bilateral myectomy and tucking of proximal muscle end: A cohort study. Middle East African Journal of Ophthalmology. 2015;22(4):457.
30. Porter JD, Baker RS, Ragusa RJ, Brueckner JK. Extraocular muscles: basic and clinical aspects of structure and function. Survey of ophthalmology. 1995;39(6):451-84.
31. Caldeira J. V-pattern esotropia: a review; and a study of the outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 78 consecutive patients. Binocular vision & strabismus quarterly. 2003;18(1):35-48; discussion 9.
32. Rutstein RP, Daum KM. Anomalies of binocular vision: diagnosis & management: Mosby Incorporated; 1998.
33. Rødahl E, Seland J, Olofsson J, Aanderud S, Kråkenes J. Surgical treatment of endocrine ophthalmopathy. Tidsskrift for den Norske Laegeforening: Tidsskrift for Praktisk Medicin, ny Raekke. 1999;119(12):1737-42.
34. Brodie SE. Photographic calibration of the Hirschberg test. Investigative ophthalmology & visual science. 1987;28(4):736-42.
35. ESKRIDGE BJ, Wick B, Perrigin D. The Hirschberg test: a double-masked clinical evaluation. Optometry and Vision Science. 1988;65(9):745-50.
36. Nowakowska O, Broniarczyk-Loba A, Loba P. The reduction of AV patterns with oblique muscles overaction in unilateral and bilateral surgery. Klinika Oczna/Acta Ophthalmologica Polonica. 2008;110(4):361-3.
37. LANG J. The meaning of A and V pattern syndromes. International Ophthalmology Clinics. 1971;11(4):70-3.
38. Von Noorden GK, Murray E, Wong SY. Superior oblique paralysis: a review of 270 cases. Archives of Ophthalmology. 1986;104(12):1771-6.
39. Manchandia AM, Demer JL. Sensitivity of the three-step test in diagnosis of superior oblique palsy. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2014;18(6):567-71.
40. Oh H, Roh Y. Head tilting in the patients with superior oblique palsy. J Korean Ophthalmol Soc. 1994;35(35):454-9.
41. Rubin SE, Wagner RS. Ocular torticollis. Survey of ophthalmology. 1986;30(6):366-76.
42. Boricean I-D, Bărar A. Understanding ocular torticollis in children. Oftalmologia (Bucharest, Romania: 1990). 2011;55(1):10-26.
43. Adler FH. Adler S Physiology of the Eye: Clinical Application 5th Ed: Mosby; 1970.
44. Akbari MR, Khorrami-Nejad M, Kangari H, Baghban AA, Pazouki MR. Ocular abnormal head posture: A literature review. Journal of current ophthalmology. 2021;33(4):379.
45. Khorrami-Nejad M, Akbari MR, Kangari H, Akbarzadeh Baghban A, Masoomian B, Ranjbar-Pazooki M. Abnormal head posture in unilateral superior oblique palsy. Journal of binocular vision and ocular motility. 2021;71(1):16-23.
46. Dietrich D, Slack W. Scoliosis secondary to unilateral extraocular muscle paresis (ocular torticollis). Radiology. 1967;88(3):538-42.
47. Roussat B, Bourreau M, Hayot B, Besson D, Goddé-Jolly D. Benign isolated 6th nerve paralysis in children. Developmental aspects apropos of 9 new cases. Ophtalmologie: Organe de la Societe Francaise D'ophtalmologie. 1989;3(2):107-8.
48. Akbari MR, Khorrami-Nejad M, Amiri MA, Baghban AA, Khosravi B, Nourizad S. Facial asymmetry in unilateral duane retraction syndrome. Optometry and Vision Science. 2019;96(12):920-4.
49. Akbari MR, Khorrami-Nejad M, Kangari H, Baghban AA, Pazouki MR. Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy. Optometry and Vision Science. 2021;98(11):1248-54.
50. PHILLIPS PH, HUNTER DG. EVALUATION OF OCULAR TORSION AND PRINCIPLES. Clinical strabismus management: Principles and surgical techniques. 1999:52.
51. Parks MM. Isolated cyclovertical muscle palsy. AMA archives of ophthalmology. 1958;60(6):1027-35.
52. Sharma P, Prasad K, Khokhar S. Cyclofusion in normal and superior oblique palsy subjects. SLACK Incorporated Thorofare, NJ; 1999. p. 264-70.
53. Bixenman WW, Von Noorden GK. Apparent foveal displacement in normal subjects and in cyclotropia. Ophthalmology. 1982;89(1):58-62.
54. Harada M. Surgical correction of cyclotropia. Jpn J Ophthalmol. 1964;8:88-96.
55. Troia RN, Nelson LB, Calhoun JH, Harley RD. Surgical correction of excyclotropia. American Orthoptic Journal. 1985;35(1):63-7.
56. Morton GV, Lucchese N, Kushner BJ. The role of funduscopy and fundus photography in strabismus diagnosis. Ophthalmology. 1983;90(10):1186-91.
| Issue | Articles in Press | |
| Section | Review Article(s) | |
| Keywords | ||
| Vertical strabismus inferior oblique overaction strabismus overelevation | ||
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How to Cite
1.
Khorrami-Nejad M, Gheibi A, Karim H, Hatem W, Abdullah M. The overaction of the inferior oblique muscle and associated vertical strabismus: prevalence, etiology, and diagnosis. jmr. 2024;(-).
