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Revista Cubana de Oftalmología

Print version ISSN 0864-2176


CASTRO PEREZ, Pedro Daniel; HERNANDEZ SANTOS, Lourdes Rita  and  GONZALEZ ROJAS, Yanileidis. Atypical paralysis of the superior oblique muscle. Rev Cubana Oftalmol [online]. 2013, vol.26, suppl.1, pp.688-693. ISSN 0864-2176.

The oculomotor paresis and paralysis involve all those processes capable of producing partial or total deficit of the ocular globe movements. The injure may be located in any part of the oculomotor system that includes the brain cortex, the brain trunk, nerves, neuromuscular plate and of the muscle. Paresis and/or paralysis of the superior oblique muscle or IV cranial nerve is very frequent in the medical practice for strabismus; it can be congenital or acquired, characterized by hypertropia that increases with the head moving toward the shoulder next to the affected eye (sign of Bielschowsky), V-anisotropy and excyclotropia. The patients affected by acquired paresis and/or paralysis show vertical and torsional diplopia that increases when they look down, torticollis from inclining the head towards the opposed side of the affected eye, and lowering of the chin. A patient went to the doctor's because he presented with vertical and torsional diplopia of 13 years of progression. The ocular motility exam revealed orthotropia at primary position of look with hyperphoria at cover test in the left eye, 10 Dp inferior basis in bar prism test, excyclotropia 5*, torticollis toward the right side and positive Bielschowsky index toward the left side. The diagnosis was acquired paresis of the left oblique superior muscle left of unspecified etiology. The treatment was over 4 mm retroinsertion of the superior rectum of the left eye plus one-fourth temporary displacement of the insertion, with the objective of eliminating the vertical and torsional diplopia and the anomalous position of the head.

Keywords : paralysis; superior oblique muscle; Bielschowsky.

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