Four-muscle tenotomy surgery for nystagmus

To describe the history and literature related to four-muscle tenotomy procedure for nystagmus.

The concept of four-muscle tenotomy surgery for nystagmus initially arose from objective eye movement recordings of patients with nystagmus and an eccentric face turn who had undergone the Anderson-Kestenbaum procedure. These eye movement recordings demonstrated secondary benefits, including broadening of the null region, improved visual acuity, and improved nystagmus waveforms. Studies initially performed in dogs validated the theory that such positive effects could be obtained by horizontal four-muscle tenotomy and reattachment without transposition. Subsequent studies in humans have demonstrated that the procedure results in improved visual acuity, broadening of the null zone, and improved target acquisition in patients with nystagmus. New theories have been described regarding techniques to augment the effects of the procedure and/or replicate its effects with a safer, less invasive alternative.

Horizontal four-muscle tenotomy has proven to be an effective procedure for reducing nystagmus, broadening the null position, and improving visual acuity in primary position for patients with nystagmus.