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      Spontaneous Recovery of Inferior Oblique Overaction in Three Saudi Children: A Case Report

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      Author(s): 1 ,
      Editor(s): ,
      Publication date (Electronic, pub):
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      Journal: Cureus
      Publisher: Cureus
      Keywords: extraocular muscle surgery, extraocular muscle, pediatrics ophthalmology, inferior oblique overaction, strabismus

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          Abstract

          The inferior oblique muscle overaction (IOOA) results in eye elevation on adduction, head tilt, difficulty in reading/writing, and changing ocular alignments in different gazes. Surgical correction is the management. We present two cases of bilateral and one case of unilateral IOOA that resolved spontaneously, and surgery differed. There was no IOOA six months after diagnosis. A sustained resolution IOOA following correction of hyperopia, improvement of vision, and esotropia correction possibly leading to rebalancing and maturing of extraocular muscles. Ophthalmologists should refer all IOOA cases to strabismologists, should not hurry to operate, counsel parents, and monitor a child’s ocular movements.

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          Primary inferior oblique overaction in congenital esotropia, accommodative esotropia, and intermittent exotropia.

          M Edward Wilson, Marshall Parks (1989)
          A statistical analysis of the onset and natural history of primary inferior oblique eye muscle overaction (IOOA) was conducted using the records of 456 strabismus patients. With 5 years or more of follow-up, IOOA developed in 72% of congenital esotropes (CETs), 34% of accommodative esotropes (AETs), and 32% of intermittent exotropes (X[T]s) at an average age of 3.6, 5.2, and 5.2 years, respectively. Incidence of IOOA was positively related to the number of horizontal surgeries in CETs but not in AETs or X(T)s. Incidence was not related to age of onset of strabismus, time from onset of strabismus to surgery, age at first surgery, or decompensation of ocular alignment. Mild IOOA did revert to normal in 12 patients after only horizontal surgery. The association of IOOA with dissociated vertical deviation, as well as symmetry, range of age of detection, and recurrence after surgery are also explored.
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            Postulating a role for connective tissue elements in inferior oblique muscle overaction (an American Ophthalmological Society thesis).

            David Stager, Linda K. McLoon, Joost Felius (2013)
            To compare the localization and density of collagens I, IV, VI, and elastin, the major protein components of connective tissue, in the inferior oblique muscle of patients with overelevation in adduction and in controls and to characterize changes that develop following surgery. Biomechanical studies suggest that the connective tissue matrix plays a critical role in extraocular muscle function, determining tensile strength and force transmission during contraction.
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              Inferior Oblique Muscle Overaction: Clinical Features and Surgical Management

              Ercan Özsoy, Abuzer Gunduz, Emrah Ozturk (2019)
              Purpose To further define the clinical features of patients with inferior oblique muscle overaction (IOOA) and evaluate the surgical results in a subgroup of these patients. Methods The medical records of 173 patients who underwent inferior oblique muscle (IO) weakening surgery due to primary or secondary IOOA were retrospectively reviewed. The patients were assigned a surgical group based on severity of IOOA and presence of dissociated vertical deviation (DVD) or hypertropia. Patients with +1 or +2 IOOA underwent recession, patients with +3 or +4 IOOA underwent myectomy, and patients with any grade of IOOA and DVD or hypertropia underwent anterior transposition (AT) surgery. Results A total of 286 eyes of 173 patients who underwent surgery due to IOOA were included in the study. IOOA was accompanied by esotropia, exotropia, abnormal head posture (AHP), pattern strabismus, convergence insufficiency, DVD, facial asymmetry, and nystagmus. The most common comorbid disorder was esotropia. The recession was used in 173 eyes, myectomy in 64, and AT in 49. Surgical success was obtained in 96.0% of eyes that underwent recession, in 98.4% of eyes that underwent myectomy, and in 93.9% of eyes that underwent AT. In the follow-up, IOOA occurred in the fellow eye in 36.1% of patients who underwent unilateral surgery. Conclusions This study is a comprehensive report on the concomitants of the IOOA. Also, it showed that all of the three surgical procedures including recession, myectomy, and AT are effective in the surgical management of IOOA when performed in select patient groups.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 27 December 2023
                Publication date (Electronic, collection): December 2023
                Volume: 15
                Issue: 12
                Electronic Location Identifier: e51152
                Affiliations
                [1 ] Ophthalmology, Qassim University, Buridah, SAU
                Author notes
                Article
                DOI: 10.7759/cureus.51152
                PMC ID: 10811612
                PubMed ID: 38283463
                SO-VID: 4f82c15b-66bb-492b-b887-d5d49316fa34
                Copyright © Copyright © 2023, AlHarkan et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 27 December 2023
                Categories
                Subject: Pediatrics
                Subject: Ophthalmology

                Keywords: extraocular muscle surgery,extraocular muscle,pediatrics ophthalmology,inferior oblique overaction,strabismus
                Data availability:
                Keywords: extraocular muscle surgery, extraocular muscle, pediatrics ophthalmology, inferior oblique overaction, strabismus

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