Superior oblique tuck for superior oblique palsy

Fifty-nine patients with a superior oblique palsy had a superior oblique tuck as part of their surgical treatment. The average size of the tuck was 12.0 mm. All cases had a decrease in the hyperdeviation in the primary position and some decrease in elevation in adduction in the operated eye (Brown's syndrome). Seventeen per cent of the patients required take-down of the tuck three to 24 months after surgery (average time for reoperation, 9.1 months). Symptoms forming indications for take down of the tuck were head tilt, vertical diplopia, torsional diplopia, and a tight feeling on elevation in adduction. No patient who had a tuck alone required take-down. Brown's syndrome was more likely to occur in cases with weakening of the antagonist inferior oblique and when a bilateral tuck of the superior oblique had been done. Taking down of the tucked tendon relieved the symptoms of Brown's syndrome in seven of 10 patients, without a recurrence of superior oblique underaction. After superior oblique tuck in all patients, a residual vertical deviation could be measured and in nearly every case a Brown's syndrome could be found.