Tightening the inferior oblique muscle
Inferior oblique muscle tightening is seldom performed. To be effective, advancement of the inferior oblique muscle requires reinsertion more posteriorly and superiorly, which is technically difficult and exposes the macula to possible injury.
Tightening the superior oblique muscle
Tightening the superior oblique tendon is discussed in Chapter 11. Tucking the superior oblique tendon enhances both its vertical and torsional effects (Video 14-9). The anterior half of the superior oblique tendon alone may be advanced temporally and somewhat anteriorly, in the Fells modification of the Harada-Ito procedure, to reduce extorsion in patients with superior oblique muscle paralysis (Video 14-10).
Superior oblique tucking.
Strabismus surgery: Fells modification of the Harada-Ito procedure.
Courtesy of John D. Ferris, FRCOphth, and Peter E. J. Davies, FRANZCO, MPH.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.