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Advanced Technical IVT

superior oblique palsy

Weakness or paralysis of the superior oblique muscle causing vertical diplopia and compensatory head positioning.

Full Definition

Superior oblique palsy is the most common cranial nerve palsy affecting extraocular muscles in children. It can be congenital or acquired, resulting in weakness of the superior oblique muscle (fourth cranial nerve). Clinical features include vertical diplopia, hypertropia that worsens in downgaze and when the head tilts toward the affected side, and compensatory head tilting away from the paralyzed muscle. The condition may be associated with facial asymmetry in long-standing cases. Diagnosis is confirmed through the Parks-Bielschowsky three-step test. Treatment options include prism glasses, superior oblique tendon tuck, or inferior oblique weakening procedures depending on severity.

Usage

Usage note: Specify congenital vs. acquired; document compensatory head positioning.

In Context

  • "The child exhibited classic signs of superior oblique palsy with compensatory head tilt to the left." — Neurological examination
  • "Congenital superior oblique palsy was confirmed by the three-step test and facial asymmetry." — Diagnostic workup report

Also known as

fourth nerve palsy trochlear nerve palsy SO palsy

Contrasted with

superior oblique overaction

Don't confuse with

inferior oblique overaction skew deviation

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