title: Residual symptomatic superior oblique palsy.
abstract: OBJECTIVE
  To determine the outcome of patients treated for residual symptomatic hyperdeviations, in a tertiary referral centre, following a previous weakening procedure of the ipsilateral Inferior Oblique (IO) muscle in Superior Oblique (SO) palsy.
  
  
  METHODS
  A retrospective review of 37 patients seen over 6 years at one institution who had remained symptomatic from a SO palsy despite having had an initial weakening procedure to their ipsilateral IO (myectomy or recession). Median age was 19 years (range 3 to 56 years). Information recorded included pre- and postoperative deviation and ocular motility findings, preoperative symptoms, findings at the time of surgery, and outcome.
  
  
  RESULTS
  Nine patients underwent repeat weakening surgery (disinsertion) on the ipsilateral IO only. Thirteen patients underwent strengthening surgery on the ipsilateral SO only. Nine patients had surgery on both the ipsilateral IO and SO. Six patients had surgery on the ipsilateral IO with either horizontal or vertical rectus surgery. Nine (24%) patients remained symptomatic after their initial procedure and are regarded as initial failures. Four of these patients had masked bilateral IO weakness. Five patients required additional surgery. At final outcome, 84% were discharged with resolution of their symptoms.
  
  
  CONCLUSIONS
  In the light of these findings we suggest an approach for the management of these patients. This should always include exploring a previously operated ipsilateral IO. Despite this, patients should be warned that they have a 1 in 4 chance of needing further surgery to achieve adequate ocular motility.
authors.affiliation: Moorfields Eye Hospital, London, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Davis
authors.forename: E
authors.initials: E
authors.lastname: Dawson
authors.forename: J P
authors.initials: JP
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D020432:Trochlear Nerve Diseases / Q000503:physiopathology* / Q000601:surgery*