J Korean Ophthalmol Soc.  1991 Mar;32(3):300-306.

Superior Oblique Palsy

  • 1Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.


I reviewed charts of 26 patients with superior oblique palsy who had been treated surgically. Diagnosis of superior oblique palsy was based on the Bielschowsky head tilt test(BHT) and overacting inferior oblique muscle. Four patients(15%) were diagnosed as having bilateral superior oblique palsy, and 22 patients(85%) were diagnosed as monocular superior oblique palsy. After myectomy of the overacting inferior oblique muscle, 6(27%) out of 22 patients initially diagnosed as monocular superior oblique palsy deveioped findings of superior oblique palsy on the opposite eye; these patients were considered as having masked bilateral superior oblique palsy. Among the 16 patients with unilateral superior oblique palsy, 11 patients(69%) showed negative BHT, 4 patients(25%) showed equivocal BHT and 1 patient(6%) still showed positive BET after surgery. Among the 14 patients who could be followed up for more than 3 months after the operation, 11 patients(79%) showed negative BHT, 2 patients(14.%) showed equivocal BHT, and 1 patient(7%) showed positive BHT. According to these results, the overacting inferior oblique muscle in superior oblique palsy plays a very important role in the elevation of the eye on ipsilateral head tilt, and the mechanism of the BHT classically described should be reconsidered. The primary operation was inferior oblique myectomy and secondary or tertiary operations were inferior oblique myectomy, marginal myotomy or superior rectus recession on the same or the other eye.


Bielschowsky head tilt test; inferior oblique myectomy; overacting inferior oblique; masked bilateral superior oblique palsy; superior oblique palsy

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