Surgery for Unilateral Superior Oblique Palsy

Illustrated for Right SOP

ClassR. HyperR.GazeSOUAIOOATreatment
1<15None0 to -1+2 to +3RIOc
2<15None-1 to-2+3 to +4RIOc or RIOmx
3a<15None-2 to -40 to +1LIRc
3b<15As 3 a but with significant torsion RSOt or Harada-Ito + LIRc
4>15Significant0 to -2+3 to +4RIOc or RIOmx + RSRc
5>15Significant-2 to-30 to +2RIOc + LIRc
6>30Significant >15-2 to -3+3 to +4RIOc + LSRs & LIRc
7a<15With spread of commitanceRSRc
7b>15With spread of commitanceRSRc + RIRs or LIRc
8<20Fallen eye syndromeLIRc

SOP: Superior Oblique Palsy
Sig: significant
SOUA: Superior oblique underaction
IOOA: Inferior oblique overaction
Treatment: Suggested treatment
RIOc: Right Inferior Oblique recessions or other weakening procedure
RSOt: Right Superior Oblique Tuck
LIRc: Left Inferior rectus recession
LSRc: Left Superior rectus recession
RSRc: Right Superior rectus recession
RIRs: Right Inferior rectus resection
RIOmx: Right Inferior Oblique Myectomy
Based on Scott WE, Kraft SP. Classification and Treatment of Superior Oblique Palsies:I. Unilateral Superior Oblique Palsies. Transactions of the New Orleans Academy of Ophthalmology. 1986: 15-38.