| Class | HT | V | IOOA | SOUA | Torsion | DMR | AHP | Treatment |
|---|---|---|---|---|---|---|---|---|
| 1 | No | 22 | >+2 | -1 to 0 | No | 10° | No | BIOc |
| 2 | No | 16 | 0 to +1 | > -2 | Yes | 13° | Chin down | BSOt or Harada-Ito |
| 3 | No | 40 | > +2 | > -2 | Yes | 14° | Chin down | BIOc & BSOt or Harada-Ito∗ |
| 4a | Yes | 21 | > +2 asym | > -2 | Yes | 14° | Tilt | Bilat. Harota-Ito or SOt and unicaat IOc |
| 4b | Yes | 20 | +1 to +2 | > -2 asym | Yes | 12° | Tilt | BSOt or Harada-Ito & IRc or SRc ± BIOc |
| 4c | Yes | 22 | > +2 asym | > -2 asym | Yes | 15° | Tilt | BIOc & BSOt or Harada-Ito & IRc or SRc |
| 5 ★ | Yes | 10 | > +2 unilat | -1 to -3 unilat | No | 6°-11° | Tilt | Unilat IOc ± IRc brings out contralateral SOP |
HT: Hypertropia in primary gaze
V: mean amount of V pattern present in upgaze/downgaze
IOOA: Inferior oblique over action
SOUA: Superior oblique under action
Torsion: Subjective torsion
DMR: Average torsion on Double Maddox Rod test
AHP: Abnormal head position
Treatment: Suggested treatment
BIOc: Bilateral Inferior Oblique recessions or other weakening procedure
BSO Tuck: Bilateral Superior Oblique Tuck
IRc: Inferior rectus recession
SRc: Superior rectus recession
Asym: Asymmetrical under or over action
Bilat: Bilateral
Unlat: Unilateral
SOP: Superior Oblique Palsy
∗ For class 3 patients: consider Bilateral Medial Rectus Recessions for Esodeviation >8 diopters
★ Masked Bilateral Superior Oblique Palsy (9-16% of all Bilateral Superior Oblique palsies)
Based on Scott WE, Kraft SP. Classification and Treatment of Superior Oblique Palsies:II. Bilateral Superior Oblique Palsies. Transactions of the New Orleans Academy of Ophthalmology. 1986: 265-91.
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