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Surgical Methods to Enhance Excyclotorsion

  • Oblique Surgery
    • Superior Oblique Tenotomy
      • weakens incyclotorsion effects of the superior oblique muscle
      • also weakens vertical effects and causes nasal shift in down-gaze
    • Inferior Oblique Anterior lateral transposition
      • Advance insertion above superior border of lateral rectus
      • Del Monte, MA, Scobee Memorial Lecture 2001, American Orthoptic Journal 2002;52:40-57
  • Vertical Rectus Surgery
    • Superior Rectus- tertiary action is incyclotorsion
      • Superior Rectus recession
        • effect will be quite small unless the muscle is tight (i.e. Graves disease)
      • Superior Rectus Nasal Transposition
        • Up to one tendon with can strengthen incyclotorsion up to 10 degrees
    • Inferior Rectus Temporal Tranposition