SUPERIOR OBLIQUE PALSY: A REVIEW OF 135 CASES

Purpose. Paresis of the superior oblique muscle is a common isolated palsy of an extraocular muscle. The aim of this study is to investigate clinical findings and surgical approaches to this ocular motility imbalance. Methods. We reviewed the records of 135 patients with superior oblique palsy who were examined in our Department of Ophthalmology over the period 2000- 2005 to evaluate the etiology, clinical patterns, surgical management and outcome. results. Congenital palsy were mostly unilateral (79%), traumatic palsy bilateral (70%). An excyclotropia of greater than 15 degrees was highly suggestive of bilaterality. Our patients reported diplopia more frequently in acquired (60%) than in con- genital (21%) superior oblique palsy. The surgical procedures were performed according to Knapp’s classification of superior oblique palsy. In 47 cases (35%) tucking of superior oblique alone corrected the full deviation. In 14 cases tucking of superior oblique was combined with weakening of inferior oblique when the deviation exceeded 30 prism dioptres. In 60 cases (45%; Knapp class 8th) tucking the superior oblique was performed concurrently with recession of superior rectus. Conclusion. In our experience surgical treatment of superior oblique palsy, according to Knapp’s classification, is not as difficult or unpredictable as that of horizontal strabismus; in fact if one uses a well thought out plan of diagnosis and treatment the results are most gratifying to the patient and to the surgeon