The inferior oblique muscle adherence syndrome

Objective: To describe the clinical features, etiology, prevention, and treatment of the inferior oblique muscle (10) adherence syndrome. Methods: This series consists of 12 patients treated for a restrictive hypotropia in which the middle portion of the 10 was scarred anteriorly, either into or near the inferior rectus muscle (IR) insertion, after prior surgery. Results: Among the 12 patients treated, the mean hypotropia of the affected eye was 18.1 +/- 7.2 prism diopters and the mean excyclotropia was 13.8 degrees +/- 3.3 degrees. Causes of the 10 adherence syndrome included IR surgery (with or without prior 10 myectomy) and scleral buckling surgery. The syndrome responded well to surgically releasing or myectomizing the incarcerated 10, combined with ipsilateral IR recession. Conclusions: The 10 adherence syndrome is a complication of surgery on the IR or of scleral buckling surgery, which can result in a restrictive hypotropia and ex-cyclotropia. It can be prevented by paying attention to the anatomic relationship between the 10 and IR and can be effectively treated if it occurs.