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Hong, Lee, and Lee: The Clinical Characteristics of Superior Oblique Palsy Associated With Intermittent Exotropia
Original Article

J Korean Ophthalmol Soc 2009;50(3):435-439.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.3.435

The Clinical Characteristics of Superior Oblique Palsy Associated With Intermittent Exotropia

Kwon Ho Hong, MD1, Young Chun Lee, MD2, Se-Youp Lee, MD1

1Department of Ophthalmology, College of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea

2Department of Ophthalmology, Uijongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea

Address reprint requests to Se-Youp Lee, MD, Department of Ophthalmology College of Medicine, Keimyung University #194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea Tel: 82-53-250-7720, Fax: 82-53-250-7705, E-mail: lsy3379@dsmc.or.kr

Received 21 July 2008       Accepted 7 October 2008

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The goal of this study was to determine the clinical characteristics of patients with intermittent exotropia (IXT) associated with hypertropia.

Methods

This study recruited 268 hospital patients with IXT associated with hypertropia. After taking history, measuring the angle of deviation, conducting an ocular motor examination, performing a Bielschowsky head tilt test and taking a fundus photograph, the clinical characteristics of 23 patients diagnosed with superior oblique palsy (SOP) were investigated.

Results

Twenty-three patients (8.6%) of the 268 subjects with IXT associated with hypertropia were diagnosed with SOP. The average angle of exodeviation was 17.1±3.8PD and the angle of hypertropia at primary position was 12.9±5.9PD. Excyclotorsion of an eyeball was observed in 19 patients (82.6%), the Bielschowsky head tilt test was positive in all patients, and head tilt or face turn was found in 12 (52.2%) patients. All subjects had inferior oblique overaction, and 20 (86.9%) had superior oblique underaction. Operations to weaken the inferior oblique muscle of the paralytic eye and for horizontal muscles were conducted at the same time. The angle of exodeviation and the angle of hypertropia were, on average, 1.8±3.6PD and 2.4±2.2PD, respectively, 6 months after the operation.

Conclusions

When patients with intermittent exotropia have hypertropia, the possibility of SOP should be considered. SOP can be detected by determining a history of head tilt and conducting a Bielschowsky head tilt test. Surgical treatment for SOP is advised.

Keywords: Bielschowsky test, Intermittent exotropia, Superior oblique palsy

References

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Table 1.
Comparison of angle of horizontal and vertical deviation in primary position between pre- and postoperative results
  Preoperative Postoperative
Angle of horizontal deviation (PD) 17.1±3.8 (12∼25) 1.8±3.6 (0∼14)
Angle of vertical deviation (PD) 12.9±5.9 (3∼25) 2.4±2.2 (0∼6)

*PD=prism diopter.

Table 2.
Prevalence of clinical characteristics of inter-
mittent exotropia associated with superior oblique palsy
Clinical charactericstics Prevalence
Ocular excyclotorsion 19 (82.6%)
Bielschowsky head tilt test positive 23 (100%)
Head tilt or face turn 12 (52.2%)
Table 3.
Comparison of prevalence of inferior oblique overaction between intermittent exotropia associated with
hypertropia and intermittent exotropia associated with superior oblique palsy
  Group I* Group II† p-value
IOOA 102/268 (38.1%) 23/23 (100%) 0.000

*Group I=intermittent exotropia associated with hypertropia

†Group II=intermittent exotropia associated with superior oblique palsy

IOOA=inferior oblique overaction.

Table 4.
Comparison of prevalence of amblypoia and loss of stereopsis between superior oblique palsy and intermittent exotropia associated with superior oblique palsy
  Group I* Group II† p-value
Amblyopia 10/67 (14.9%) 4/23 (17.4%) 0.785
Loss of stereopsis‡ 7/51 (13.7%) 5/18 (27.7%) 0.226

*Group I=superior oblique palsy

†Group II=intermittent exotropia associated with superior oblique palsy

‡Loss of stereopsis=more than 120 seconds.

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