superior oblique tuck
A superior oblique tuck is a strengthening procedure that folds the superior oblique tendon on itself and fastens the fold, enhancing the pull of the muscle.1,2 Tucking is usually reserved for the superior oblique in fourth nerve palsy.1
The surgeon draws the folded tendon into a tendon tucker and secures the tuck with two 5-0 nonabsorbable sutures. The length of tendon tucked usually runs 6 to 12 mm and depends on how tight or slack the tendon is. Congenital palsies get larger tucks than acquired palsies, where the tendon is often tight.2
The tuck improves depression of the adducted eye and counters excyclotropia.2 One complication is an inability to elevate the adducted eye, similar to Brown syndrome. The restriction usually subsides over several months but can be permanent.2 Mild elastic restriction on forced ductions at the end of surgery is the desired result, and the surgeon undoes the tuck and tucks less tendon if the restriction is severe.2,3
More detail
In the Knapp classification of superior oblique palsy, a tendon tuck or plication strengthens the paretic superior oblique in class 2, where the large deviation lies in the field of action of that muscle. The tendon must be lax on the exaggerated forced duction test, or a severe Brown syndrome may result.3 Recessing the inferior rectus of the fellow eye is the alternative when the surgeon prefers not to tuck.3 In class 3, where all contralateral gaze fields are affected, superior oblique strengthening or inferior oblique weakening alone suits vertical deviations below 20 PD.3
Sources (14)
- Pickwell's Binocular Vision Anomalies, ch. 17
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 26
- Yanoff and Duker, Ophthalmology (2023), ch. 11
- Agarwal, S. (2020). Strabismus Surgery. In: Agarwal, S. (ed.) Strabismus Simplified. Springer, Singapore. https://doi.org/10.1007/978-981-15-2135-0_9
- American Academy of Ophthalmology (2020). Superior Oblique Tuck. [online] Available at: https://www.aao.org/education/basic-skills/strabismus-surgery-superior-oblique-tuck [Accessed 8 May 2024].
- Bradfield, Y.S., Struck, M.C., Kushner, B.J., Galal, A., Drummond, G.T. and Keech, R.V. (2012). Surgical treatment of acquired superior oblique palsy. Journal of American Association for Pediatric Ophthalmology and Strabismus, 16(5), pp.460-463.
- Kushner, B.J. (2017). Strabismus. In: Olitsky, S.E. (ed.) Pediatric Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-28315-5_10
- Rutstein, R. and Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management. St. Louis: Mosby.
- Sharma, P., Gogri, P., Nagpal, R. and Garg, P. (2021). Superior Oblique Tuck. In: Agarwal, S. (ed.) Strabismus Simplified. Springer, Singapore. https://doi.org/10.1007/978-3-030-53058-7_88
- Superior oblique tuck: evaluation of surgical outcomes - PubMed
- Superior oblique tuck for superior oblique palsy - PubMed
- Simultaneous Harada-Ito and superior oblique tendon tuck
- Superior oblique tuck—effectiveness in reducing vertical deviations ...
- Superior Oblique Tuck - SpringerLink
Reviewed October 2026