Superior oblique palsy: A case report

Abstract: Superior oblique palsy is known to be caused by a defect of the trochlear nerve which could lead to horizontal and most times noticeable vertical misalignment of the eye. A case of superior oblique palsy (SOP) determined during a routine eye examination of a 16-year-old female with a complaint of blurring of vision at far and near with intermittent vertical diplopia while reading was presented. She showed right hypertropia and left exotropia of 10ΔBD and 9ΔBI, respectively, at far with fast recovery on right head tilt. Also, 12ΔBI and 12ΔBD for near with the left eye fixing. Parks–Bielschowsky three-step test showed that the patient’s hypertropia and vision increased on the right in the primary position while diplopia decreases when chin is depressed and her head is tilted to the left. Congenital superior oblique palsy can present with vertical diplopia in childhood or adulthood when contralateral head tilt is no longer enough to compensate for the vertical imbalance due to the decompensation of the vertical fusional reserve. Therefore, child’s old pictures are very important in confirming longstanding SOP and patching can be used to relief the diplopia