Looking for info on inferior oblique myectomy surgery (For 4th nerve palsy/diplopia/strabismus)

I'm a 20 year old male and have had fourth nerve palsy (AKA superior oblique palsy) since early childhood.  It's resulted in strabismus and diplopia. When I'm reading anything up close I'll have to shut my left eye or else I won't be able to focus on the page.  I also have never been able to look through binoculars with both eyes; I'll have to always keep my left one shut.  When I look in a mirror and move my face in close and try to focus on the reflection very close-up I'll notice my left eye drifting up and to the left while my right stays in place.  My head is apparently also always tilted, although I've never noticed this myself.

Well, the double vision has gotten worse recently so I figured it's time to do something about it.  I consulted a doctor and was told a simple, quick surgery called an inferior oblique myectomy should straighten things out.  I looked it up online and found surprisingly few results.  I looked it up in conjunction with "fourth nerve palsy" and found even less.  Most of the results I've found have been nothing but medical jargon, seemingly aimed at practicing doctors or people in medical school...I haven't found a single result anywhere online so far of someone who has actually undergone this surgery and talks about it.  I also haven't found it mentioned on any forums and haven't found any pages that talk about it in a relatable way; like I said, strictly medical journal type stuff.  I'm anxious about surgery in general and the idea of a scalpel going into my eye makes me shudder whenever I think of it and was hoping to find some reassurance on the internet from others who have had this done, but I've found nothing.  The internet is a big place and the world is even bigger, so to find no testimonials on this surgery at all makes me a bit apprehensive.  Is this a rare or uncommon surgery?  And exactly how risky is it?  If anyone here could share their knowledge or experience on the subject it would be much appreciated.  Thanks!

[Sandra M Brown, MD]

Go to the public forum section of www.aapos.org to find other patients who have undergone strabismus surgery.

Superior oblique palsy has a number of different surgical treatments.  Inferior oblique myectomy is certainly one treatment.  It has the least chance of over-correction (reversing your left eye from high to low).  A superior oblique tuck is another procedure, a 'stronger' procedure, which some doctors feel is better for people who tilt their heads, however it does have a chance of over-correction if your eyes are fairly level when you look straight ahead.  Sometimes treatment involves weakening the inferior rectus of the opposite eye.  The exact procedure depends on the pattern of eye misalignment.  I am assuming that your eye doctor measured your eye drifting with your head in different positions, and you can determine yourself the position of maximum misalignment just by noting how you hold your head to make the images as far apart as possible.  You can certainly ask your doctor to explain why he is suggesting the specific procedure of IO myectomy and he should have a comprehensible answer for you.

You will not find useful information on success rates on line because patients with SO palsy include apples, oranges and bananas (so to speak) so it is impossible to make generalized statements about different procedures and their outcomes.