An Orbital Approach to Superior Oblique Myokymia: Superior Oblique Myectomy and Trochlear Resection.
Susan Luo, Salma A Dawoud, Gerald J Harris
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Case in brief
Four patients with superior oblique myokymia and refractory oscillopsia had symptoms for 10 to 22 years and had not responded to medical therapy. Three had recurrent myokymia after superior oblique tenectomy, while one remained symptomatic after three transcranial microvascular decompressions. All underwent superior oblique myectomy with trochlear resection and reported sustained, complete resolution of oscillopsia, with postoperative follow-up of 22, 17, 16, and 2 years. Three did not need further strabismus surgery; three reported mild, non-bothersome supra- and infratrochlear hypesthesia.
What made this case unusual
The report describes sustained complete symptom resolution after an orbital procedure in patients with refractory disease, including recurrence after tenectomy and persistent symptoms despite three transcranial microvascular decompressions.
Diagnostic / clinical pearl
For superior oblique myokymia unresponsive or intolerant to medical therapy, superior oblique myectomy with trochlear resection is a surgical option, including after failed tenectomy; further strabismus surgery may be needed.