Superior oblique palsy: diagnosis and treatment

To pinpoint the diagnostic dilemmas and to look for differentiating preoperative features in cases of masked bilateral superior oblique palsy, the authors reviewed the charts of 50 patients (26 males and 24 females with an average age at presentation of 25.6 years) with an established diagnosis of superior oblique palsy seen between 1980 and 1987. Most patients had a history of symptoms from childhood or following trauma. Typically, patients complained of torticollis and diplopia and manifested inferior oblique overaction and superior oblique underaction of the paretic eye. Twenty-two of the patients underwent a total of 28 operations; surgery resulted in elimination of symptoms and neutralization of the hyperdeviation in 77%. On the basis of this experience the authors discuss the presenting features and the differential diagnosis of superior oblique palsy and present a rational approach to surgical intervention.