[Direct superior oblique muscle trauma and dysfunction--surgical possibilities and results]

Direct trauma to the superior-oblique muscle of the eyeball may result in active and passive ocular motility disturbance, e.g. paresis, Brown phenomenon, cyclorotation disorder, head-tilt and faulty head posture. In individual cases combinations of these and rather complex forms may occur. Surgery should aim at sufficient centralization of the binocular field of vision. The author usually recommends indirect procedures, at the ipsilateral inferior oblique muscle, to correct excyclorotation, or at the contralateral inferior rectus muscle to correct paresis. A pronounced Brown phenomenon should be treated by recession of the superior oblique muscle, or rather its transposition to the nasal side of the superior rectus. In addition, recession of the contralateral superior-rectus muscle or resection of the ipsilateral inferior-rectus muscle may be advisable. Out of eight patients, one refused surgery, five were sufficiently cured in one session, and another patient in three surgical sessions. One patient could not be satisfactority treated by surgery; in addition to a Brown phenomenon she had excyclorotation, especially in down-gaze, and paresis of the superior oblique muscle plus severe neuralgic pain in up-gaze. In this patient the trochlea had been accidentally lost during a foreign-body excision in the upper medial orbit. A secondary reconstruction of the trochlea was found not to be advisable in this patient, because the neuralgia was thought to be due to traction within the superior oblique tendon or the periost.