Anterior nasal transposition of the inferior oblique muscle can cause antielevation syndrome

We present a case of acquired severe excyclotropia that occurred following multiple orbital wall fracture and traumatic superior oblique palsy in an 18-year-old man. The patient suffered from severe torsional diplopia in the right eye; double Maddox rod testing showed excylotorsion of 25°. After anterior nasal transposition of the right inferior oblique muscle, His subjective torsional diplopia improved; however, severe antielevation syndrome was noted after surgery.