Acquired central disruption of fusional amplitude is characterized by a complete loss of fusional amplitude, the patient maintaining fusion for only a moment under test conditions before breaking to constant diplopia. Under normal viewing conditions, the patient has constant diplopia with both eyes open. Patients who have bilateral superior oblique palsy may mimic this loss of fusion and consta...

CLINICAL PEARLS Lesions of the fourth (trochlear) cranial nerve cause vertical or oblique diplopia by impairing the ability of the superior oblique muscle to intort and depress the eye. This binocular diplopia worsens in downgaze and lateral gaze away from the affected eye. Because intorsion is necessary to maintain fusion in ocular counter-roll, this diplopia also worsens with head tilt toward...

A 27 year old woman with systemic lupus erythematosus (SLE) developed vertical diplopia with an apparent bilateral inferior oblique muscle palsy, resulting in a limitation of elevation of the globe in adduction. It resolved with systemic steroid treatment. A transient tenosynovitis affecting the superior oblique tendons was the probable underlying pathological mechanism. This is the first descr...

PURPOSE To establish the surgical results and residual symptoms in 48 cases with unilateral congenital superior oblique muscle palsy that had surgical intervention to the vertical muscles alone. METHODS Myectomy and concomitant disinsertion of the inferior oblique (IO) muscle was performed in 38 cases and myectomy and concomitant IO disinsertion and recession of the superior rectus muscle in ...

Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewe...