6 Pediatric Ophthalmology and Strabismus
Part I: Strabismus
Chapter 11: Vertical Deviations
Vertical Deviations With Marked Horizontal Incomitance
Inferior Oblique Muscle Palsy
Whether inferior oblique muscle palsy (Fig 11-5) actually exists has been questioned. Most cases are considered to be congenital or posttraumatic.
Inferior oblique palsy is suspected when the patient has hypotropia and 3-step-test results consistent with this diagnosis. As with Brown syndrome, a prominent feature is deficient elevation when the eye is in adduction. The features that distinguish inferior oblique palsy from Brown syndrome are listed in Table 11-4.
Indications for treatment of inferior oblique muscle palsy are abnormal head position, vertical deviation in primary position, and diplopia. Management consists of weakening either the ipsilateral superior oblique muscle or the contralateral superior rectus muscle.
Figure 11-5 Left inferior oblique palsy. When the patient fixates with the paretic eye, there is a right hypertropia in primary position that is also most prominent in right gaze and with head tilt to the right—the 3-step test is consistent with this diagnosis. This patient had no abnormal neurologic findings.
(Courtesy of Steven M. Archer, MD.)
Table 11-4 Comparison of Inferior Oblique Muscle Palsy and Brown Syndrome
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.