Treatment of DVD is indicated if the deviation is noticeable (generally more than 6Δ–8Δ) and occurs frequently during the day. When DVD is unilateral or highly asymmetric, encouraging fixation by the eye with greater DVD by optically blurring the fellow eye is sometimes sufficient. Because DVD can mimic OEAd, distinguishing it from overaction of the inferior oblique muscles is important, as the surgical approaches to these 2 conditions are different in most cases.
Surgery on the vertical muscles often improves the condition but rarely eliminates it. Recessions of the superior rectus muscle, ranging from 6 to 10 mm according to the size of the hypertropia, can be effective. If there is residual DVD after superior rectus muscle recession, inferior rectus muscle resection or plication can be performed. Inferior oblique muscle anterior transposition is also effective in treating DVD, especially if it is accompanied by inferior oblique muscle overaction. Bilateral surgery is performed whenever both eyes can fixate; asymmetric surgery is an option if the DVD is asymmetric.
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.