If the torque vector of the muscle is not abnormal, alteration of muscle function—an increase or a decrease—would result from a change in the force generated by the muscle, as well as from changes in the torque generated by its antagonist muscle. Denervation of skeletal muscle results in atrophy that is characterized by a smaller than normal cross-sectional area,20- 24 and greater muscle strength can be associated with hypertrophy (an increase in muscle fiber size) or, to a lesser degree, with hyperplasia (an increase in the number of muscle fibers),25 both of which result in a larger than normal total cross-sectional area. However, EOMs have a unique response to denervation. They show a pattern of atrophy that differs from that seen in other striated muscles, which indicates some degree of resilience to denervation.20- 22,26 The paradigm that a stronger than normal muscle should have an increased cross-sectional area and that a paretic muscle should have a smaller than normal cross-sectional area leads to numerous inconsistencies with respect to clinical observations. For example, some patients with the clinical picture of superior oblique muscle paresis have a normal-sized superior oblique muscle as determined by magnetic resonance imaging.27 In superior rectus muscle overaction or contracture syndrome, the superior rectus muscle is often of normal size, and forced ductions may be normal.3,28,29 Size of the superior oblique muscle does not correlate with the magnitude of the Bielschowsky head tilt phenomenon in patients with superior oblique muscle palsy.30 Although the contralesional superior oblique muscle has been shown to be larger than normal in patients with unilateral superior oblique muscle palsy,31 I have never seen objective intorsion in the contralesional eye of such patients even when studied prospectively.32 If enlargement of the contralesional superior oblique muscle indicated that it was stronger than normal, one would expect to see the eye intorted even in the primary position, as contractile force generated by the resting tonus of the muscle should be greater than normal. Finally, the degree of inferior oblique muscle “overaction” in patients with primary inferior oblique muscle “overaction” does not correlate with the size of the “overacting” muscle.31 Certainly, any attempt to assess EOM size by orbital imaging may potentially be flawed because of artifacts from positioning, technique, or volume averaging. However, the aforementioned studies described rigorous controls to eliminate such errors.