Session: Poster session B

Incomitance-base management of superior oblique palsy

Introduction: The clinical findings of the superior oblique palsy, whether be congenital or acquired, are dominated by excyclotorsional diplopia, hypertropia and the compensatory head tilts to the opposite side. Depending on the time of evolution, the deviation can differ with the positions of the gaze. There are different surgical options depending on the incomitance. Knapp had proposed different surgical plannings according to the clinical presentations.



Methods: We present 5 clinical cases with congenital paralysis of the fourth nerve that differ from each other in the incomitance of their strabismus and we show the surgical results of each case through preoperative and postoperative photographs.



Results: Model 1: Hypertropia less than 10 Prism Diopters (PD), worse hypertropia on the opposite gaze position, excyclotorsión, inferior oblique weakening surgery. Model 2: Hypertropia of 20 PD, adduction and abduction hypertropia, and also in down gaze abduction positions, ipsilateral versions were more affected, mild incyclotorsion; recession of the ipsilateral superior rectus surgery was performed. Model 3: hypertropia of 10 PD that increase on the inferior gaze positions; recession of the contralateral inferior rectus. Model 4: Child patient, more than 20 PD hypertropia, also in adduction with severe head tilt; recession of the ipsilateral inferior oblique and plication of the superior oblique surgery. Model 5: Adult patient, more than 20 PD hypertropia in adult patient, worse hypertropia on the opposite gaze position, mild head tilt; recession of the ipsilateral inferior oblique and recession of the contralateral inferior rectus surgery were performed.



Conclusions: A correct and thorough examination of ocular motility in patients with fourth cranial nerve palsy, including ocular incomitance and torsion, is very important to decide the better surgical option in each particular case.