====== Surgery for Bilateral Superior Oblique Palsy ======

^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.\\

{{tag>Strabismus_Surgery}}