Restrictive Strabismus -How to Devise a Strategy-

Abstract

　Here, we have evaluated the appropriate surgical procedure for strabismus in thyroid eye disease. This section focuses on cases with vertical strabismus, especially those in which the inferior rectus（IR）is affected. Since vertical deviation decreases in the downward gaze, it is necessary to set the target ocular alignment such that diplopia is eliminated in the downward gaze.

When the unilateral IR is affected and the vertical deviation is severe, recession of the contralateral superior rectus along with recession of the affected IR is adequate. However, when bilateral IR are affected, bilateral asymmetric recession of the IR is necessary to eliminate the abnormal head posture（chin up）and diplopia in the primary position. Furthermore, nasal transposition of IR is additionally performed in the case of excyclotorsion. Recently, the effectiveness of botulinum therapy for strabismus in thyroid eye disease has been commonly reported. It is expected that botulinum therapy in combination with strabismus surgery will further improve the treatment results for strabismus in patients with thyroid eye disease.