Clinical Features and Natural Course of Superior Oblique Palsy

Hyun Joo; So Young Kim

doi:10.3341/jkos.2013.54.4.627

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Joo and Kim: Clinical Features and Natural Course of Superior Oblique Palsy

Original Article

J Korean Ophthalmol Soc 2007;54(4):627-631.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.4.627

Clinical Features and Natural Course of Superior Oblique Palsy

Hyun Joo, MD, So Young Kim, MD, PhD

Department of Ophthalmology, Soonchunhyang University College of Medicine, Cheonan, Korea

Address reprint requests to So Young Kim, MD, PhD Department of Ophthalmology, Soonchunhyang University Cheonan Hospital #31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 330-721, Korea Tel: 82-41-570-2260, Fax: 82-41-570-2261, E-mail: ophdrkim@gmail.com

Received 25 May 201231 July 2012 Accepted 16 January 2013

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

To evaluate the natural course of superior oblique palsy (SOP) with objective criteria, and to show the contemporary etiology and recovery rates among several factors. The clinical features of SOP were compared to previous studies.

Methods

A retrospective chart review of 80 patients diagnosed with SOP between January 1, 2006 and December 31, 2011 was performed.

Results

Clinical SOP features showed variation when compared to previous studies. Out of 80 patients, 71 were identified with unilateral isolated and 9 bilateral cases of SOP. Twenty cases were congenital and 60 cases were acquired SOPs. Acquired SOPs were affected most commonly by trauma (31%) and vascular disease (30%). Twenty-four out of 49 patients, who were followed up over 2 months after the first visit recovered, especially vascular origin cases, which was statistically significant (75%, p = 0.000). Patients with initial vertical deviation smaller than 5 Prism diopters (PD) experienced a more successful recovery than patients with an initial deviation larger than 5 PD.

Conclusions

SOP has different recovery rates depending on the etiology. Accurate ocular examination and understanding of SOP etiology are necessary for successful treatment.

Keywords: Etiology, Natural history, Paralytic strabismus, Superior oblique palsy, Trochlear nerve palsy

References

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Table 1.

Baseline characteristics of the total subjects (n = 80) and the patients who were followed up over 2 months since the initial examination among the total 80 subjects (n' = 65)

		n / n'	Mean age (Age ± SD)	Recovered SOP^*	Persistent SOP^*	p-value
Gender	Male	46 / 39	44.0 ± 23.3	17	22	0.173^†
	Female	34 / 26	36.9 ± 26.1	7	19
Laterality	Unilateral	71 /57	42.9 ± 24.8	22	35	0.372^‡
	Bilateral	9 / 8	26.1 ± 17.9	2	6
Etiologies	Congenital	20 (25%) / 19	7.6 ± 5.3	0 (0%)	19	0.000^‡
	Trauma	25 (31%) / 21	41.9 ± 14.7	7 (33.3%)	14	0.679^†
	Vascular	24 (30%) / 16	63.5 ± 9.8	12 (75%)	4	0.000^‡
	Neoplasm	2 (3%) / 2	30.0 ± 11.3	0 (0%)	2	0.394^‡
	Undetermined	9 (11%) / 7	55.3 ± 20.4	5 (71.4%)	2	0.058^‡
	Total	80 (100%) / 65	41.0 ± 24.6	24	41

SD = standard deviation.

^* Superior oblique palsy

^† Chi square test

^‡ Fisher's exact test.

Table 2.

The relationship between initial prism diopters of each etiology and recovery rate

	Mean initial prism (±SD)	Mean initial prism of Recovered SOP	Mean initial prism of Persistent SOP	p-value
Congenital	6.3 (±8.4)	-	-	-
Trauma	6.3 (±8.4)	4.1 (±4.0)	7.4 (±9.8)	0.429^*
Vascular	3.2 (±2.1)	2.5 (±2.1)	4.7 (±1.5)	0.063^†
Neoplasm	5.0 (±7.0)	-	-	-
Undetermined	6.7 (±5.1)	6.2 (±5.5)	8.0 (±5.6)	0.688^†

Abbreviations are same as Table 1 and 2.

^* t-test

^† Mann-Whitney test.

Table 3.

Relationship between initial deviation and recovery rate of superior oblique palsy

	Initial prism	n	Recovered SOP^*	Persistent SOP	p-value
Congenital	≤5 PD^†	7	0	7	-
>5 PD	7	0	7
Trauma	≤5 PD	15	6	9	0.613^‡
>5 PD	6	1	5
Vascular	≤5 PD	12	10	2	0.154^‡
>5 PD	3	1	2
Neoplasm	≤5 PD	1	0	1	-
>5 PD	1	0	1
Undetermined	≤5 PD	4	3	1	1.000^‡
>5 PD	3	2	1
Total	≤5 PD	39	19	20	0.048^‡
>5 PD	20	4	16

This statistics included 59 patients with exact initial deviation (PD, prism diopters) which were followed up over 2 months.

^* Superior oblique palsy

^† Prism diopter

^‡ Fisher's exact test.

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