Abstract
Thirty-four patients with surgically treated bilateral superior oblique palsy are presented.
The patients are divided into three groups:
(1) Symmetrical palsies,
(2) Asymmetrical palsies,
(3) 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° 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.
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Price, N., Vickers, S., Lee, J. et al. The diagnosis and surgical management of acquired bilateral superior oblique palsy. Eye 1, 78–85 (1987). https://doi.org/10.1038/eye.1987.12
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DOI: https://doi.org/10.1038/eye.1987.12
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