The Triple Forced Duction Test(s) for diagnosis and treatment of superior oblique palsy -- with an updated flow chart for unilateral superior oblique palsy.
OBJECTIVE
To review and update the management of superior oblique extraocular muscle clinical paresis and palsy, (SOP) employing and applying recent advances in the diagnosis and surgical methods.


METHODS
These include three recently introduced forced duction tests, respectively for laxity of the SO tendon, absence of the SO tendon, and contracture of the ipsilateral superior rectus muscle. Also discussed are the pathophysiologic mechanisms behind various modes of clinical presentation of SOP, older concepts requiring scrutiny, and prior surgical methods which should no longer be employed due to advances in our knowledge.


CONCLUSIONS
These newer aspects of SOP management are organized and displayed in a revised Plager flow sheet to facilitate their application.
Mims
James L
JL
D019091:Critical Pathways; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D017410:Practice Guidelines as Topic; D020432:Trochlear Nerve Diseases / Q000175:diagnosis* / Q000628:therapy*; D015348:Vision, Binocular