J Korean Ophthalmol Soc.  1988 Apr;29(2):363-369.

The Evaluation and Treatment of Superior Oblique Muscle Palsy

• Cho YA

Abstract

Superior oblique palsy is the most common isolated palsy of an extraocular muscle and the most frequent cause of vertical strabismus. Patients with superior oblique palsy are frequently symptomatic from diplopia, anomalous head postures and loss of binocular vision, and showed hyperdeviation in primary position on the prism cover test, positive three step test and unilateral oblique muscle dysfunction on version. The surgical treatment of superior oblique palsy is very important because it not only prevents musculoskeletal changes from occurring in the face and neck by the elimination of abnormal head postures, but also corrects hypertropia and excydotropia in the primary position and preserves and improves stereopsis. The author had 52 patients of unilateral superior oblique palsy treated with superior oblique tucking, weakening of inferior oblique (recession, and denervation and extirpation of inferior oblique), recession of contralateral inferior rectus and ipsilateral superior oblique recession. The results were as follows. Children under 10 years of age were 71.2% of the patients. The average amount of hyperdeviaiton in primary position was 24.0 delta with range of 4 to 70 delta. Maddox double rod test was performed in 22 patients who understood it and all of them showed excyclodeviation of either eye. The range was 2 to 10 degrees with average of 5.2 degrees. Stereopsis was present in 77.1% of all the patients, in 91.3% of superior oblique palsy alone combined with horizontal strabismus before surgery. Following inferior oblique weakening procedure, the mean correction of hyperdeviation in primary position was 15.7 delta by 10 mm recession, 20.4 delta by 14 mm recession and 38.3 delta by denervation and extirpation of inferior oblique muscle.

MeSH Terms

Child
Denervation
Depth Perception
Diplopia
Exercise Test
Head
Humans
Neck
Paralysis*
Posture
Strabismus
Vision, Binocular