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tenotomy

A tenotomy is the operation of cutting a muscle tendon.1 Free tenotomies of the rectus muscles have been replaced by recessions, yet tenotomy of the superior oblique tendon is still performed.2 Tenotomy of the inferior rectus is an exception among the rectus muscles, used in rare cases of severe endocrine ophthalmopathy or congenital fibrosis where the muscle is too tight to pass sutures through its tendon at the insertion.2

Severing the tendon is one of several ways to weaken the superior oblique, along with recession, lengthening with a silicone expander and excision of a piece of tendon.2 Once the continuity of the tendon is completely disrupted, the effect is the same wherever the tenotomy is done and whether or not the surrounding sheath is cut.2 Superior oblique tenotomy treats an A pattern caused by oblique dysfunction. A posterior tenotomy corrects about 20 prism diopters of A pattern, and a total tenotomy corrects up to 50 prism diopters.3

More detail

A tenotomy of the posterior fibers of the superior oblique tendon selectively weakens the muscle's vertical action without altering its cycloducting effect, and surgeons have used it to collapse an A pattern with mild to moderate superior oblique overaction.2 In one comparison of surgical results, tenotomy and recession of the superior oblique tendon proved equally effective.2

Sources (23)
  1. Pickwell's Binocular Vision Anomalies, Appendix (Glossary)
  2. Binocular Vision and Ocular Motility, ch. 26
  3. Kanski's Clinical Ophthalmology (2024), ch. 18
  4. Agarwal, S. (2020). Strabismus Surgery. In: Agarwal, S. (ed.) Strabismus Simplified. Springer, Singapore. https://doi.org/10.1007/978-981-15-2135-0_9
  5. Hardesty, H.H. (1972). Superior Oblique Tenotomy. Archives of Ophthalmology, 88(2), pp.181-184.
  6. 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
  7. Rutstein, R. and Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management. St. Louis: Mosby.
  8. von Noorden, G. and Campos, E. (2002). Binocular Vision and Ocular Motility. 6th ed. St. Louis: Mosby.
  9. Yurdakul, N.S. and Ugurlu, S. (2013). Graded superior oblique tenotomy in patients with superior oblique overaction. Indian Journal of Ophthalmology, 61(11), pp.650-654.
  10. PubMed Central: PMC5448732
  11. JAMA Network: 630638
  12. PubMed Central: PMC7052466
  13. europe.ophthalmologytimes.com: pearls-for-minimally-invasive-strabismus-surgery
  14. PubMed Central: PMC3858822
  15. MDPI: 5657
  16. PubMed: 20126485
  17. American Academy of Ophthalmology: superior-oblique-z-tenotomy
  18. PubMed: 26614476
  19. reviewofophthalmology.com: my-10-commandments-for-strabismus-surgery
  20. EyeRounds (University of Iowa): superior-oblique-tenotomy.htm
  21. EyeWiki: Strabismus_Surgery,_Cyclovertical
  22. PubMed Central: PMC6975027
  23. American Academy of Ophthalmology: strabismus-surgery-posterior-90-tenotomy

Reviewed October 2026

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