[Paresis of the superior oblique eye muscle]

Congenital or acquired palsy of the superior oblique eye muscle presents a clinical picture which is consistent and recognizable. The diagnosis is based upon two clinical findings: hypertropia of the affected eye with a greater than normal vertical deviation in adduction, and an increase of the hypertropia when tilting the head towards the affected side (positive Bielschowsky test). In the majority of cases the dominant feature of the clinical picture is overreaction of the ipsilateral inferior oblique. We have retrospectively examined 22 patients with superior oblique palsy who underwent surgery. Median follow-up time was three months. 20 (91%) of the patients were operated primarily by performing a recession of the ipsilateral inferior oblique muscle. Additional surgery had to be performed on five patients. The final postoperative examination showed the result to be a success in 19 (86%) of the patients, judged on relief of symptoms and objective measurements. We conclude that in the majority of cases surgical treatment of superior oblique palsy by recession of the ipsilateral inferior oblique gives good results.