Kushner et al described the inferior oblique muscle adherence syndrome, in which the inferior oblique muscle is entrapped in fibrous tissue near the insertion of the inferior rectus muscle. This results in an acquired defect in ocular motility. The author is from the University of Wisconsin in Madison.


Clinical features in the affected eye:

(1) large hypotropia

(2) restricted movement when trying to elevate the eye

(3) excyclotropia with restricted incyclorotation

(4) history of ocular surgery

(4a) scleral buckling

(4b) surgery on the inferior rectus muscle, especially in patients with a history of a prior myectomy of the inferior oblique muscle



• Excyclotropia = upper pole of the globe's vertical axis is deviated away from midline towards the temple


The risk of occurrence can be reduced during operations on the inferior rectus muscle

(1) hook the muscle from the nasal side if possible

(2) if the temporal approach is used, be sure not to pass the hook too far posteriorly

(3) be sure the inferior oblique muscle is not incorporated into the hook


Patients with the adherence syndrome tend to have good outcomes following surgical release of the trapped tissue.


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