Superior Oblique Palsy and Your Vision

Superior oblique palsy, also known as trochlear nerve palsy or fourth nerve palsy, happens when the superior oblique muscle is weak, resulting in a misalignment of the eyes. This misalignment can be vertical, horizontal or torsional. This weakness can vary in degrees from slight to severe. Even a minor weakness of the muscle can bring on symptoms.

Common Symptoms: Double Vision, Headaches & More

Superior oblique palsy can also cause double vision because the brain sees an image from two different directions. Another common symptom is a head tilt to help with double vision. This head tilt is very noticeable. Without any treatment, a person with superior oblique palsy can also develop headaches, dizziness, and nausea.

Superior oblique palsy can be caused by trauma usually involving the head, such as in a concussion, or be congenital, meaning present at birth because of anomalies such as a misshapen skull. In rare cases, superior oblique palsy can also be caused by a stroke, tumor, or aneurysm.

Post Concussive Syndrome and Traumatic Brain Injury (TBI)

People who suffer from post-concussive syndrome have also been known to experience superior oblique palsy. If you have had a traumatic brain injury (TBI), the oblique muscle connected to a very long nerve can become damaged, leading to weakness and the development of superior oblique palsy.

How to Treat Superior Oblique Palsy

For all cases where you or someone you know has acquired superior oblique palsy, it is essential to figure out the cause first. After the cause is treated, your eye doctor will wait a period of six months to see if the muscles recover and the palsy spontaneously and naturally resolves. During this period, you can manage any double vision symptoms with realigning prism glasses. Prism glasses can also help reduce or eliminate headache and dizziness symptoms.

Prism lenses create a unified image by directing both eyes towards a central middle area so that the brain interprets the two images from the left and right eye as one image. In severe cases, you may need surgery for your eye muscles to correct the double vision, head tilt, and eye drift. Surgery may involve one or both eyes to address the misalignment.