An Orbital Approach to Superior Oblique Myokymia: Superior Oblique Myectomy and Trochlear Resection

Superior oblique myectomy and trochlear resection is a surgical option for patients with superior oblique myokymia unresponsive to, or intolerant of, medical therapy. It can be used if superior oblique tenectomy fails, or it can be considered as primary surgical management. Further strabismus surgery may be required after this procedure. If used primarily, compensatory inferior oblique weakening should be planned, as it is following primary superior oblique tenectomy. In our view, the orbital approach is preferable to transcranial microvascular decompression.