Clinical Aspects of Prevention and Management of Primary Inferior Oblique Muscle Overaction

Background. Primary inferior oblique muscle overaction (PIOOA) may occur for various reasons and happens to 72 % patients with infantile esotropia. The criterion for the first surgical step is prevalence of vertical or horizontal deviation. The choice of tactics weakening inferior oblique muscle is ambiguous.

Aims: to carry out retrospective analysis of PIOOA frequency in patients with infantile esotropia; to assess influence of esodeviation reduction by a surgical, chemodenervational or prismatic method on the existing PIOOA dynamics; to assess clinical and functional results of PIOOA treatment.

Methods and methods. The retrospective analysis of 572 patients’ cases lay in assessment of PIOOA frequency and rate in patients with infantile esotropia that manifested under 9 months, with different treatment tactics. The prospective part of the research included two groups of patients. Group 1 (106 patients, 222 eyes) – studying the influence of surgical treatment of PIOOA. Group 2 (127 patients, 207 eyes) – studying the effectiveness of surgical PIOOA treatment. Conclusion. PIOOA frequency in case of different treatment tactics for patients with infantile esotropia is from 17 to 69 %, and the degree of its clinical manifestation is from 1.2 ± 0.4 to 2.6 ± 0.8. Bilateral weakening of medial rectus muscle reduces its probability up to 17–19 %, and the degree of its manifestation up to 1.2 ± 0.4. In cases of combination of PIOOA with infantile esotropia from 20 to 25° with paretic component, it is reasonable to carry out esodeviation reduction by means of bilateral recession, chemorecession or prismatic correction as the first treatment stage, whereas the rate of existing PIOOA is credibly reduced. In cases of choice of tactics, which is necessary for clinically significant reduction or elimination of PIOOA, it is reasonable to carry out chemorecession, marginal partial myotomy or myectomy depending on the PIOOA manifestation.

1. De Camargo GB, Hida WT, Goldchmit M, Uesugui CF, de Souza-Dias CR. Paralytic strabismus: review of 24 years at“Santa Casa de São Paulo”. Arq Bras Oftalmol. 2007; 70(4): 585-587. doi: 10.1590/S0004-27492007000400005

2. Govindan M, Mohney BG, Diehl NN, Burke JP. Incidence and types of childhood exotropia: a population-based study. Ophthalmology. 2005; 112(1): 104-108. doi: 10.1016/j.ophtha.2004.07.033

3. Greenberg AE, Mohney BG, Diehl NN, Burke JP. Incidence and types of childhood esotropia: a population-based study. Ophthalmology. 2007; 114(1): 170-174. doi: 10.1016/j.ophtha.2006.05.072

4. Von Noorden GK, Campos EC. Binocular vision and ocular motility: theory and management of strabismus. St Louis: Mosby; 2002.

5. Caldeira JA. 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. Binocul Vis Strabismus Q. 2004; 19(3): 139-150.

6. Hertle RW. A next step in naming and classification of eye movement disorders and strabismus. JAAPOS. 2002; 6(4): 201-202. doi: 10.1067/mpa.2002.126491

7. Chang BL, Yang SW. Inferior oblique overaction. Korean J Ophthalmol. 1988; 2(2): 77-81. doi: 10.3341/kjo.1988.2.2.77

8. Kushner BJ. Multiple mechanisms of extraocular muscle “overaction”. Arch Ophthalmol. 2006; 124(5): 680-688. doi: 10.1001/archopht.124.5.680

9. Mims JL 3rd. Alternate explanations for inferior oblique muscle “overaction”. Arch Ophthalmol. 2006; 124: 1797-1798. doi: 10.1001/archopht.124.12.1797-b

10. Anderson JR. Sidelights on the inferior oblique muscle. Br J Ophthalmol. 1948; 32(9): 653-668. doi: 10.1136/bjo.32.9.653

11. Slavin ML, Potash SD, Rubin SE. Asymptomatic physiologic hyperdeviation peripheral gaze. Ophthalmology. 1988; 95(6): 778-781. doi: 10.1016/S0161-6420(88)33108-8

12. Clark RA. The role of extraocular muscle pulleys in incomitant non-paralytic strabismus. Middle East Afr JOphthalmol. 2015; 22(3): 279-285. doi: 10.4103/0974-9233.159698

13. Clark RA, Choy AE, Demer JL. Inferiorly displaced lateral rectus pulley causes recurrent esotropia after strabismus surgery. J AAPOS. 2007; 11(1): 86-87. doi: 10.1016/j. jaapos.2006.11.082

14. Clark RA, Miller JM, Rosenbaum AL, Demer JL. Heterotopic muscle pulleys or oblique muscle dysfunction? J AAPOS. 1998; 2(1): 17-25. doi: 10.1016/S1091-8531(98)90105-7

15. Wright KW. Color atlas of strabismus surgery: strategies and techniques. Springer-Verlag New York; 2007. doi: 10.1007/978-0387-68625-7

16. Brodsky MC, Donahue SP. Primary oblique muscle overreaction. Arch Ophthalmol. 2001; 119(9): 1307-1314. doi: 10.1001/archopht.119.9.1307

17. Hoyt CS, Taylor D. Pediatric ophthalmology and strabismus. Saunders Ltd; 2012.

18. Parks MM, Mitchell PR. Cranial nerve palsies. In Tasman W, Jaeger EA. (eds): Duane’s Clinical Ophthalmology. Vol. 1. Philadelphia: JB Lippincott Co; 1993.

19. Wilson ME, Parks MM. Primary inferior oblique overaction in congenital esotropia, accommodative esotropia, and intermittent exotropia.Ophthalmology. 1989; 96(7): 950-957. doi: 10.1016/S0161-6420(89)32774-6

20. Parks MM. The overacting inferior oblique muscle: The XXXVI DeSchweinitz lecture. Am J Ophthalmol. 1974; 77(6): 787797. doi: 10.1016/0002-9394(74)90381-X

21. Parks MM, Mitchell PR. Oblique muscle dysfunctions. In: Tasman W, Jaeger EA. (eds.): Duane’s Clinical Ophthalmology. Vol. 1. Philadelphia: JB Lippincott Co; 1991.

22. Hiles DA, Watson BA, Biglan AW. Characteristics of infantile esotropia following early bimedial rectus recession. Arch Ophthalmol. 1980; 98(4): 697-703. doi: 10.1001/archopht.1980.01020030691008

23. 2014-2015 Basic and Clinical Science Course, Section 06: Pediatric Ophthalmology and Strabismus. San Francisco: American Academy of Ophthalmology; 2014.

24. Wright KW, Strube YNJ. Color atlas of strabismus surgery: strategies and techniques. 4th ed. Springer-Verlag New York; 2015. doi: 10.1007/978-1-4939-1480-7

25. Sanjari MS, Shahraki K, Nekoozadeh S, Tabatabaee SM, Shahraki K, Aghdam KA. Surgical treatments in inferior oblique muscle overaction. J Ophthalmic Vis Res. 2014; 9(3): 291-295 doi: 10.4103/2008-322X.143355

26. Plisov IL, Anciferova NG, Pushchina VB. Primary inferior oblique muscle overaction in infantile esotropia: can we prevent its development? Nevskie gorizonty – 2018: Materialy nauchnoy konferentsii oftal’mologov. Sankt-Peterburg: Politekhnika-servis; 2018. p. 155-156. (In Russ.)

27. Plisov IL, Puzyrevsky KG, Ozernoy AI, Antsiferova NG, Batalova OM. Methods and tactics of treatment of paralytic strabismus. Sovremennye problemy diagnostiki i lecheniya zabolevaniya glaz. Trudykonferentsii, posvyashchennoy 80-letiyu NGIUVAikafedry oftal’mologii. Novokuznetsk; 2007. p. 49-52 (In Russ.)

28. Plisov IL, Chernyh VV, Anciferova NG, Pushchina VB. Rehabilitation of patients with primary inferior oblique muscle overaction. Sovremennye tekhnologii v oftal’mologii. 2018; (3): 251-253. (In Russ.)