The inferior oblique muscle adherence syndrome.

OBJECTIVE To describe the clinical features, etiology, prevention, and treatment of the inferior oblique muscle (IO) adherence syndrome. METHODS This series consists of 12 patients treated for a restrictive hypotropia in which the middle portion of the IO 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 IO adherence syndrome included IR surgery (with or without prior IO myectomy) and scleral buckling surgery. The syndrome responded well to surgically releasing or myectomizing the incarcerated IO, combined with ipsilateral IR recession. CONCLUSIONS The IO adherence syndrome is a complication of surgery on the IR or of scleral buckling surgery, which can result in a restrictive hypotropia and excyclotropia. It can be prevented by paying attention to the anatomic relationship between the IO and IR and can be effectively treated if it occurs.