Treatment of congenital adduction palsy with synergistic divergence.

OBJECTIVE: To report on successful management of congenital adduction palsy with synergistic divergence by performing weakening surgery on the superior and inferior oblique muscles.
METHODS: We performed a total tenotomy of the lateral rectus muscle, followed by resection of the medial rectus muscle and tenotomy of the superior oblique and myectomy of the inferior oblique muscles in a patient who had congenital adduction palsy with synergistic divergence.
RESULTS: Total tenotomy of the lateral rectus muscle had no effect on synergistic divergence, resection of the medial rectus muscle reduced it to some extent and tenotomy of the superior oblique and myectomy of the inferior oblique muscles further reduced this phenomenon. The improvement in synergistic divergence was maintained at 2 1/2 years later at follow up.
CONCLUSIONS: Weakening surgery on the superior and inferior oblique muscles should be considered in the management of synergistic divergence.