Superior oblique tendon weakening procedures are used in the management of superior oblique overaction, inferior oblique palsy, and Brown’s syndrome (see Chap. 7 ). Weaking the superior oblique muscle by tenotomy or tenectomy is uncontrolled. The cut tendon ends can separate causing a palsy or even scar back together causing recurrence of the strabismus. In general, patients with binocular fusion such as Brown’s syndrome are better served with a controlled lengthening procedure like the Wright superior oblique tendon expander.