History

42 year old woman with previous history surgical weakening of superior obliques with silicone spacers. Has to maintain an extreme chin-down position while walking, going down stairs and reading.

Surgery

Bilateral superior oblique exploration, repeat tenectomy, removal of silicone spacers, and re-recess superior recti, OD from 11 to 13 mm from limbus and OS from 8 to 14 mm from limbus.