Superior
oblique palsy is the most common oculo-motor nerve
palsy encountered by strabismologists and should not
present any diagnosis difficulties .
when a strabismologist is asked about congenital
head tilt , the diagnosis of superior oblique palsy
should arise as a first possibility.
The 3 step test
(positive Bielschowsky test) - Hypertropia in
the primary position increases on looking nasally
and on head tilt to the same side of the hypertropia
- is diagnostic of SO palsy
In cases of class I superior oblique palsy
with a maximum hyperdeviation of no greater than 25
prism diopters weakening of the antagonist inferior
oblique is effective.
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