Ask an Expert: Superior Oblique Palsy

Eye and Vision Care

Superior Oblique Palsy
03/29/2011

Question:

what happens if you dont treat superior oblique palsy

Answer:

Thank you for this interesting question. Unfortunately, the answer is not as simple as the question.

When I see a patient with a superior oblique palsy (fourth cranial nerve palsy), the first question that I need to answer is "what is the cause of the nerve palsy?"

Some common causes are:
Congenital (it has been present since birth)
Trauma induced (such as from a motor vehicle accident)
Related to blood vessel function (such as with diabetes)
Due to something creating pressure on the brain (such as a tumor)
If the underlying cause of the nerve palsy is likely to progress or cause further damage (for example diabetes or a tumor), failure to treat the underlying cause can lead to further complications or even death.

Now for actually treating a superior oblique palsy...

The most common treatments include eye muscle surgery, prism glasses, or wearing a patch to eliminate double vision.

What happens if the nerve palsy is not treated? Well this is also a little complicated as it depends on age.

In a young child, failure to treat a superior oblique palsy may result in development of amblyopia or lazy eye (reduced visual function in the eye with the nerve palsy), reduced depth perception, and/or an abnormal head posture.

In an adult, failure to treat a superior oblique palsy may lead to an abnormal head posture and persistence of the signs and symptoms that are currently being experienced (for example: double vision, uncomfortable vision, reduced depth perception, cosmetic misalignment of eyes).

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Response by:

Andrew J Toole, OD, PhD, FAAO
Clinical Assistant Professor of Optometry
College of Optometry
The Ohio State University