Anterior and temporal transposition of the superior oblique for treatment of exotropia in oculomotor nerve palsy

Strabismus secondary to oculomotor nerve palsy is difficult to treat due to paralysis of multiple extraocular muscles. Established surgical techniques include supramaximal recession of the lateral rectus muscle, creation of a medial periosteal flap to tether the globe, and lateral rectus orbital wall fixation.1-3 Nasal transposition of the lateral rectus muscle is also possible but carries the risk of optic nerve compression, serous retinal detachment, and anomalous globe retraction.