Superior oblique myokymia: when treatment is necessary

A 56-year-old woman presented with a 10-year history of torsional diplopia and right monocular oscillopsia. These symptoms, which had been intermittent at first, continued practically uninterrupted during the last 2 years. She was diagnosed as having superior oblique myokymia of the right eye. Adequate trials of oral carbamazepine, baclofen and phenytoin were unsuccessful in suppressing her symptoms. One year after her initial presentation, she underwent a right superior oblique tenectomy and a right inferior oblique recession. She eventually required a second operation on her other eye to cure her of an annoying diplopia on down-gaze.