The Namaste Sign: Surgical Management of Superior Oblique Palsy

Drs. Ramesh Kekunnaya and Mayank Jain demonstrate use of the "Namaste technique" in a 5-year-old child with superior oblique palsy with superior oblique tuck and inferior oblique myectomy. The patient had left-hand tilt and outward deviation of the right eye from birth, with a 20 PD of right hypertropia. An inferotemporal conjunctival fornix incision was made and both the lateral rectus and inferior rectus were hooked. The inferior oblique was teased out and hooked, and after artery forceps were applied the muscle was cut and thoroughly cauterized. The surgeons then turned their attention to the superior oblique. To determine how much of the superior oblique needed to be tucked, they looked to the Namaste greeting, where the hands are folded. Similarly, both ends of the superior oblique can be folded on themselves as much as possible, because of the muscle's laxity.