The diagnosis and surgical management of acquired bilateral superior oblique palsy

Abstract

Thirty-four patients with surgically treated bilateral superior oblique palsy are presented. The patients are divided into three groups: Symmetrical palsies, Asymmetrical palsies, A group in whom the bilaterality was initially masked. Bilaterality should be suspected in all cases of traumatic IVth nerve paresis, and particularly in cases with a large 'V' pattern, excyclo deviation of more than 10 degrees on down-gaze and when right hypertropia switches to left hypertropia on lateral down-gaze. Bilateral Harada-Ito procedures alone 'cured' 11 of 17 patients (65 per cent) in groups 1 and 2, and is the operation of choice in acute bilateral superior oblique palsy. Cyclo deviation was reduced by a mean of 5.5 degrees in the primary position and by 6-10 degrees in down-gaze. Patients initially managed with other surgery had a more complicated surgical course and required more operations. Seven patients who initially demonstrated only gross fusion recovered good fusion after Harada-Ito surgery.

Simulated torsional disparity disrupts horizontal fusion and stereopsis

“…8,9 This is largely due to a significant increase in excyclotropia in downgaze, as demonstrated in studies by Kraft and coworkers 10 and Georgievski and Kowal, 11 the latter measuring an increase in the mean excyclotropia from primary position to downgaze of 6% and 106% in patients with unilateral and bilateral superior oblique palsy, respectively.…”

Cranial nerve palsies in childhood

“…Fells and his team 13 reviewed the management of bilateral superior oblique palsy and stressed the importance of dealing with any significant torsion as a primary procedure, using his modification of the Harada Ito procedure. Failure to deal with the torsion was an important barrier to a satisfactory fusion result in this series.…”

Neurogenic Palsies

“…Price et al (1987), reviewing their series of acquired bilateral superior oblique palsy, concluded that about 38% were initially masked. Price et al (1987), reviewing their series of acquired bilateral superior oblique palsy, concluded that about 38% were initially masked.…”