Superior Oblique Palsy Combined with Horizontal Strabismus

ABSTRACT

PURPOSE: To investigate the clinical characteristics of superior oblique palsy in patients with horizontal strabismus. METHODS: Nineteen superior oblique palsy patients with vertical deviation or inferior oblique overaction who complained horizontal deviation were evaluated. Visual acuity, ocular movement test, prism cover test, Bielschowsky head tilt test, fundus photograph and examining photographs for head tilt and facial asymmetry were performed. Horizontal strabismus surgery and inferior oblique myectomy was done simultaneously , and the postoperative results was compared with preoperative condition. RESULTS: There were 15 exotropic patients (22.20PD+/-6.01SD) and 4 esotropic patients (22.00PD+/-12.08SD). Vertical deviation was found to be 6.74PD+/-3.35SD. Inferior oblique overaction (+0.5~2) was observed in 18 patients. Twelve patients had excyclotorsion. Of 18 patients with head tilting and 12 patients with facial asymmetry, seven patients (38.9%) in head tiltilng and six patients (50%) in facial asymmetry did not notice the abnormality. Horizontal strabismus surgery with inferior oblique myectomy showed good results in all cases. CONCLUSIONS: We should consider the possibility of superior oblique palsy when the patients showed small amount of vertical deviation, head tilt, facial asymmetry or monocular inferior oblique overaction combined with horizontal strabismus, and do the surgery simultaneously for horizontal strabismus and superior oblique palsy.