Thyroid ophtalmopathy manifesting as superior oblique paralysis
Jan-Tjeerd de Faber in 28th European Strabismological Association Meeting, 2020
It is known that the oblique muscles are rarely involved in thyroid ophtalmomyopathy, and the studies investigating the involvement of these muscles are also rare [8,9,13–15]. Additionally, there are only a few studies about the cases who present with a paralysis of the superior oblique simulating the superior oblique involvement as an initial sign of the thyroid ophthalmopathy [9]. In this study the cases arising as a paralysis of the superior oblique muscle and at the same time showing an involvement of the inferior oblique were evaluated. The relationship between the paralysis of the superior oblique and the thyroid ophtalmopathy can be explained in 5 different ways [9]. The most plausible explanation is that probably the paralysis of the superior oblique precedes Graves disease rather than being a result of this disorder. It becomes symptomatic by the diminution of fusion due to the Graves disease [13]. In our 7 patients whose history did not include any cause of the paralysis of the 4th nerve, the most acceptable assumption is the preceding asymptomatic paralysis of the superior oblique that becomes symptomatic after decompensation by diminution in fusion related to the disease.
An Approach to Oculomotor Anomalies in a Child
Vivek Lal in A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
The three ocular motor nerves innervate the six extraocular muscles as well as the levator palpebrae superioris (LPS) and the pupillary constrictors. The oculomotor nerve innervates the LPS, superior rectus (SR), inferior rectus, medial rectus, inferior oblique, and the pupillary constrictors. The trochlear nerve innervates the superior oblique muscle, and the abducens nerve innervates the lateral rectus muscle. The pathways involved in supranuclear control of the ocular motor nerves descend from the cerebral cortex and terminate in the brainstem in the omnipause neurons (for horizontal saccades) and the rostral interstitial nucleus of the medial longitudinal fasciculus of the midbrain (vertical saccades).
Eye
Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod in The Primary FRCA Structured Oral Examination Study Guide 1, 2017
Remember ‘LR6SO4’. Lateral rectus muscle is supplied by the sixth cranial nerve (abducens nerve).Superior oblique muscle is supplied by the fourth cranial nerve (trochlear nerve).All of the other extraocular muscles (medial rectus, superior rectus, inferior rectus and inferior oblique) are supplied by the third cranial nerve (oculomotor nerve).
Nasal insertion of the superior oblique tendon presenting as Brown syndrome
Published in Strabismus, 2022
Ahmed Awadein, Ahmed Adel Youssef, Jylan Gouda
The superior oblique muscle originates from the lesser wing of sphenoid bone, passes forward along the nasal wall through the trochlea, and then changes its direction to be inserted in the posterolateral quadrant of the globe. The insertion is fan shaped, concave forward and oblique. The line passing from trochlea to the insertion makes an angle of approximately 55 degrees with the sagittal axis. In the primary position, the superior oblique muscle is responsible for abduction, depression and intorsion of the globe. Isolated anomalous ocular muscle insertions without craniofacial anomalies are not widely encountered. Superior oblique abnormalities include an anomalous posterior course of the tendon, with insertion nasal to the superior rectus tendon. This abnormality has been reported in patients with congenital fibrosis syndrome. In this report, we describe two cases with an abnormally nasally inserted superior oblique muscles presenting with a Brown syndrome-like clinical picture.
Correction of horizontal and torsional compensatory head posture in infantile nystagmus syndrome using horizontal rectus muscle recession and resection with vertical transposition
Published in Strabismus, 2022
Vibha Baldev, Shailja Tibrewal, Soveeta Rath, Suma Ganesh
In patients with head tilt, excyclotorsion and incyclotorsion must be induced to correct the CHP. To achieve this, surgery can be done on the oblique, the vertical rectus or the horizontal muscles. Surgery on oblique muscles involve weakening of anterior fibers of superior oblique muscle (50% anterior tenectomy) to create extorsion in one eye and simultaneous weakening (recession) of inferior oblique muscle and/or strengthening of the anterior fibers of superior oblique muscle (Harada Ito procedure) in the contralateral eye to create intorsion. Lueder and Galli15 described optimal correction (mean 28º) of head tilt in six patients, and Pehere and Sutraye1 reported excellent correction (25º) in one patient with the above technique. Prakash et al.16 documented success in correcting head tilt with all four oblique muscles recession/advancement in one patient.
Extra-large V pattern in exotropia: a rare case and its management
Published in Strabismus, 2020
Shailja Tibrewal, Manasvini Sharma, Soveeta Rath, Suma Ganesh
V pattern exotropia is a vertical gaze incomitance of more than 15 Prism Dioptres (PD) between upgaze and downgaze with eyes diverging more in upgaze. The various causal mechanisms for this abnormality are overaction of inferior oblique muscles (IO),1 overaction or increased innervation of the lateral rectus muscle (LR) in up-gaze or medial rectus muscle in down-gaze,2,3 displacement of rectus muscle pulleys or its path,4 ex-cyclorotation of the orbits as in craniofacial anomalies5 and desagitalisation of the superior oblique muscle in plagiocephaly.6 The underlying pathophysiology of the motility disturbance leading to V pattern in an otherwise comitant horizontal strabismus, has been attributed to overelevation in adduction,7 and/or ex-cyclorotation of the globes,8 both of which may result from loss of sensory fusion. The management of the V pattern along with the horizontal strabismus is important to avoid postoperative esotropia in downgaze and abnormal head posture.
Related Knowledge Centers
- Eye
- Lateral Rectus Muscle
- Superior Rectus Muscle
- Trochlear Nerve
- Frontal Bone
- Sclera
- Anatomical Terms of Muscle
- Orbit
- Extraocular Muscles
- Trochlea of Superior Oblique