Superior Oblique Palsy: Epidemiology and Clinical Spectrum From a Tertiary Eye Care Center in South India.

Purpose: The objective of this study was to describe the epidemiologic characteristics and clinical spectrum of superior oblique palsy (SOP) at a tertiary eye care center.

Design: This was a retrospective case review.

Methods: Retrospective analysis of case records of 181 consecutive patients diagnosed with SOP seen from January 2001 to December 2008 was performed.

Results: The mean age of the patients was 31.78 ± 19.28 years (range, 1-85 years). One hundred thirty-six (75.1%) were males, and 45 (24.9%) were females. Most common presenting symptom was manifest vertical deviation (81.7%). Most common etiology was trauma (33.7%) followed by a congenital (32.6%), idiopathic (23.7%), and ischemic (8.8%) etiology. One patient each had multiple myeloma and central nervous system tuberculoma. Bilateral SOP was noted in 11 cases; 7 (63.4%) of them were posttraumatic, 3 (27.3%) were congenital, and 1 developed after cerebrovascular accident. Neuroimaging performed in 67 patients (37%) with suspected central nervous system pathology was positive in 10 (14.9%) of patients. The distribution of neuroimaging abnormalities was traumatic sequelae in 5 patients (50%), intracranial space-occupying lesion in 1 (10%), granuloma in dorsal midbrain in 1 (10%), and ischemic lesions (lacunar infarcts, occipital lobe infarcts) in 3 (30%) patients.

Conclusions: Superior oblique palsy etiology tends to show an age and sex distribution. Trauma and congenital etiologies are the most common in young males and females, respectively, whereas ischemic etiology is more frequent in middle-aged and elderly people. Detailed history, meticulous ocular and systemic examination, appropriate neuroimaging, and systemic investigations help elucidate the etiology.