Superior oblique paralysis. A review of 270 cases
G. K. von Noorden, E. Murray and S. Y. Wong
In 270 patients with superior oblique paralyses treated between 1973 and
1984, congenital and traumatic causes were most frequent, and one fourth of
all traumatic cases had bilateral involvement. Among the diagnostic
features distinguishing bilateral from unilateral paralysis were a right
hypertropia in left gaze and left hypertropia in right gaze, and a positive
Bielschowsky test on tilting the head toward either shoulder. However,
absence of either sign did not exclude bilateral paralysis. Large
excyclotropia and a V-pattern esotropia are suggestive of but not
diagnostic for bilateral paralysis. Complaints about cyclotropia are
limited to acquired paralysis. Cyclotropia in the normal eye, head tilt
toward the involved side, or absence of any abnormal head posture limits
the diagnostic value of these associated signs. Overshoot of the
contralateral superior oblique occurred in 19% of the patients and is
thought to be caused by contracture of the ipsilateral superior rectus
muscle. Surgical treatment in 112 patients resulted in an 85% cure rate
with an average of 1.45 operations per patient.
