Congenital absence of the superior oblique tendon

Congenital absence of the superior oblique tendon occurred in 18% of patients with a diagnosis of congenital superior oblique palsy who were treated with an attempt at a tuck of the superior oblique tendon. The presence of horizontal strabismus and amblyopia in a patient with diagnosis of congenital superior oblique palsy should raise the possibility of absence of this tendon. Absence of the superior oblique tendon can be treated successfully with weakening of the antagonist inferior oblique, and either recession of the yoke inferior rectus or the ipsilateral superior rectus. The horizontal deviation can be treated with appropriate recession and resection of the horizontal recti.