Superior oblique tendon incarceration syndrome.

OBJECTIVE To describe the clinical features, etiology, and management of superior oblique tendon incarceration syndrome. METHODS This series consists of all patients I treated between September 15, 1974, and March 1, 2006, for restrictive hypertropia in which the superior oblique tendon was found scarred to the superior rectus muscle insertion after prior surgery. RESULTS Twenty eyes in 18 patients were included in this series. The mean+/-SD hypertropia of the affected eye was 15.4+/-9.0 prism diopters, and the mean+/-SD incyclotropia was 15.0 degrees+/-3.5 degrees. Causes of superior oblique tendon incarceration syndrome included prior superior rectus muscle resection, recession, plication, or transposition; superior oblique tendon recession, disinsertion, or posterior tenectomy; and scleral buckling surgery. The syndrome was difficult to treat and required a mean+/-SD of 1.9+/-0.7 additional surgical procedures to correct. CONCLUSIONS Superior oblique tendon incarceration syndrome is a complication of surgery on the superior rectus muscle or superior oblique tendon that can result in restrictive hypertropia and incyclotropia. Proper handling of the connection between the superior oblique tendon and superior rectus muscle at the time of surgery may prevent this complication, which can be difficult to treat.