J Korean Ophthalmol Soc.  2008 May;49(5):865-870. 10.3341/jkos.2008.49.5.865.

A Case of Congenital Inferior Oblique Palsy

• Lee KH
• Kyung SE

• KMID: 2211721
• DOI: http://doi.org/10.3341/jkos.2008.49.5.865

Abstract

PURPOSE: Paresis of the inferior oblique is the least likely to result in paralysis. We report a patient without a history of trauma successfully treated using contralateral IO recession and SR recession.
CASE SUMMARY
A 25-year-old male patient presented to us with an extended history of abnormal head posture, manifested by a marked habitual left head tilt with a face turn to the right. A cover test in the primary position demonstrated 15 prism diopter right hypertropia, which increased to 25 prism diopter right hypertropia in right gaze and 20 prism diopter right hypertropia in right head tilt. The patient was diagnosed with IO palsy, and a right IO recession was performed. RESULTS: Following the IO recession, head tilt was completely resolved and face turn to the right was slightly resolved. Cover test in the primary position demonstrated 12 prism diopter right hypertropia, which increased to 20 prism diopter right hypertropia in right gaze. A head tilt test demonstrated a symmetrical 12 prism diopter right hypertropia. We performed a right SR recession to decrease face turn and hypertropia in the primary position.
CONCLUSIONS
We report a patient manifesting abnormal head posture diagnosed with IO palsy, which was successfully treated using contralateral IO recession and SR recession.

Keyword

Congenital inferior oblique palsy; Inferior oblique anterior transposition

MeSH Terms

Adult
Head
Humans
Male
Paralysis
Paresis
Posture
Strabismus

Figure

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  Figure 1. The child showed left head tilt with a face turn to the right.

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  Figure 2. The patient shows head tilt to the left shoulder and face turn to the right.

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  Figure 3. Preoperative fundus photographs showing incyclotorsion in the left eye.

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  Figure 4. Preoperative 9 cardinal gaze photographs. RHT (right hypertropia) increased with right gaze and on head tilt to the right side.

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  Figure 5. Nine cardinal gaze photographs after IO recession of the right eye.

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  Figure 6. Nine cardinal gaze photographs after SR recession of the right eye.

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  Figure 7. The patient does not show head tilting and turning after right superior rectus recession.

Reference

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