Transactions 29th European Strabismological Association Meeting – de Faber (ed) © 2005 European Strabismological Association, ISBN 04 1537 211 9

Outcome of surgical management in adults with congenital unilateral superior oblique palsy

Department of Strabismology, Cracow Eye Hospital, Kraków, Poland

1INTRODUCTION

Congenital superior oblique palsy (SOP) is usually diagnosed and treated in childhood. However, there is a group of patients in whom SOP becomes symptomatic later in life. We wanted to analize the effectiveness of different surgical methods in adults with SOP.

2METHODS

A retrospective review of 23 adult patients with congenital superior oblique palsy who underwent surgical correction at our department over a ten year period. Preoperative and postoperative vertical deviations were measured in nine diagnostic positions on a major amblyoscope.

3RESULTS

There were a total of 29 operations: inferior oblique recession was performed in 21 patients, superior oblique tuck in 7 and a contralateral inferior rectus recession in 1 patient. 17 patients underwent muscle surgery once and 6 were operated twice. An average of 1,3 surgeries were performed per patient. The mean preoperative vertical deviaton was 16 in the primary position and 16 in the reading position. The average final postoperative vertical deviation was 3 in the primary position and 5 in the reading position. The mean reduction of vertical deviation was 13 in the primary position and 11 in the reading position. The mean reduction of vertical deviation in the primary position in the inferior oblique recession group (12 ) was found to be significantly greater than in the superior oblique tuck group (8 ), (p 0,009). Even though the mean reduction of vertical deviation in the reading position in the inferior oblique recession group (9 ) was greater than in the superior oblique tuck group (7 ), no statistically significant difference was found.

4CONCLUSIONS

1.Successful treatment of adult patients with congenital superior oblique palsy can be accomplished in the majority of cases.

2.Recession of the inferior oblique was found to be more effective than superior oblique tuck in the reduction of primary position hypertropia in adults with congenital superior oblique palsy.

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Transactions 29th European Strabismological Association Meeting – de Faber (ed) © 2005 European Strabismological Association, ISBN 04 1537 211 9

Inhibitional palsy of the contralateral superior rectus muscle in a patient with superior oblique paresis

B. Kaczmarek, E. Wójcik & C. Bilska

Department of Strabismology, Cracow Eye Hospital, Kraków, Poland

1INTRODUCTION

Usually the diagnosis of superior oblique palsy is straightforward. Diagnostic difficulties may sometimes arise when the patient dominantly fixates with the paralyzed eye.

2CASE REPORT

A 35 year female presented with hypotropia of 40 , marked ptosis and restriction of elevation of her right, amblyopic eye. Careful examination revealed left superior oblique palsy. The Bielschowsky test confirmed the diagnosis. Left inferior oblique recession was performed. Vertical deviation was decreased to 15 and ptosis disappeared. The preand postoperative vertical deviation measurements as well as photographic documentation are presented.

3DISCUSSION

Since the patients right eye is amblopic she habitually fixates with the paralyzed left eye. Left inferior oblique overaction, according to Herring’s law of equal innervation, causes decreased innervation of the right superior rectus causing so-called inhibitional palsy of the contralateral antagonist.

4CONCLUSION

Trochlear palsy can present in an atypical form and can mimic a contralateral III nerve palsy.

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