Modified Harada-Ito Procedure in Acquired Superior Oblique Palsy with Exotropia

Superior oblique palsy is the most common isolated cranial nerve palsy and is commonly associated with exotropia. Modified Harada-Ito procedure can be used to correct excyclotorsion in symptomatic patients. We report a case of acquired superior oblique palsy with exotropia undergoing modified Harada-Ito procedure. A 33 years old man presented with torsional diplopia. On examination there was 10 degrees of left excyclotorsion on double Maddox rod with 25-diopter of exotropia on primary gaze and 20-diopter on lateral gaze suggestive of lateral incomitancy. He underwent a Fells modification of Harada-Ito procedure with bilateral rectus recession. Three months postoperative, he was orthophoric. Modified Harada-Ito procedure is a successful procedure in overcoming torsional diplopia. It is important to identify lateral incomitancy to prevent overcorrection of the horizontal deviation.