Two patients who presented with compensatory head postures and diplopia are described. They both had marked unilateral superior oblique overaction, in one patient due to a large, incomitant skew deviation. Each underwent a superior oblique tendon lengthening procedure using a segment of silicone 240 retinal band as an expander, in combination with a contralateral superior rectus recession. Both...

PURPOSE To evaluate the outcomes of botulinum toxin injection into the inferior oblique (IO) muscle for management of unilateral acute traumatic superior oblique (SO) palsy. METHODS In this prospective case series, 10-20 units of botulinum toxin A (Dysport, Ipsen, Biopharm Ltd., Wrexham, UK) was injected into the ipsilateral IO muscle of 13 consecutive patients with unilateral acute traumatic...

OBJECTIVE To analyze the vestibulo-ocular reflex (VOR) in patients with unilateral peripheral third nerve palsy. PARTICIPANTS AND METHODS Ten patients and 15 healthy subjects were studied using magnetic search coils. Subjects made sinusoidal +/-10 degrees head-on-body rotations in yaw, pitch, and roll in darkness and during monocular viewing in light. RESULTS Horizontal VOR and visually enh...

OBJECTIVE To seek evidence for causative secondary changes in extraocular muscle volume, cross-sectional area, and contractility in superior oblique (SO) palsy using magnetic resonance imaging, given that vertical deviations in SO palsy greatly exceed those explained by loss of SO vertical action alone. METHODS High-resolution, quasi-coronal orbital magnetic resonance images in target-control...