Dr. Ken Wright performs a superior oblique tenotomy with interposed silicone expander. This technique is indicated for any superior oblique overaction including Brown syndrome.

Following dissection and retraction of the conjunctiva, the superior oblique tendon is isolated. Opposing Stevens hooks are used to stretch the tendon and provide exposure. Two double-arm 5-0 nonabsorbable (Mersilene) sutures are placed in the tendon with locking bites 2 to 3 mm apart. The superior oblique tendon is cut between these sutures. Dr. Wright performs exaggerated forced ductions to ensure a complete tenotomy.

A 5-mm silicone band is secured with each needle from the Mersilene sutures. The sutures are tied to secure the silicone expander between the cut ends of the superior oblique tendon, thereby lengthening the tendon and providing a controlled weakening effect. Video adapted from Pediatric Ophthalmology and Strabismus (Oxford University Press, 2012).