title: Bilateral superior oblique palsy: etiology and therapeutic options.
abstract: OBJECTIVE
  To study the causes of bilateral superior oblique palsy (BSOP), treatment with botulinum toxin and/or surgery, and outcome of treatment.
  
  
  METHODS
  This was an 11-year retrospective study of patients with BSOP treated with injections of botulinum toxin (Botox), surgery, or both. Treatment was considered successful when anomalous head turn and diplopia in primary gaze position and downgaze resolved.
  
  
  RESULTS
  Bilateral superior oblique palsy was diagnosed in 12 patients (8 male; mean age, 29.5 years). Palsy was secondary to a neoplasm in 3 cases and to head trauma in 2. In 2 cases, it was ischemic, in 2 it was congenital; the remaining cases were iatrogenic (hydrocephalus secondary to meningitis, 1), hemorrhagic (1), and idiopathic (1). The clinical manifestations recorded were diplopia (10), anomalous head posture (9), V pattern (12), subjective excyclotorsion (8), and objective excyclotorsion (6). Recovery was spontaneous in 1 case with neoplastic disease. Botox was injected in 8 cases (inferior oblique and/or inferior rectus muscles [successful in 2]), and subsequent surgery was required in 6. Two patients underwent surgery without prior injection of Botox. The most common surgical technique was recession of the inferior oblique muscle (6 patients), either as the only operation or associated with other procedures. The final result was good in 72.72% (8/11). Mean follow-up was 62.6 months (range 9-99 months).
  
  
  CONCLUSIONS
  Causes of BSOP were varied (most frequently neoplastic). Botox was effective as the only treatment in 25% (2/8). Outcome was good in a high percentage of cases with Botox, surgery, or both.
authors.affiliation: University General Hospital Gregorio Marañon, Madrid - Spain.
authors.forename: Pilar S
authors.initials: PS
authors.lastname: Merino
authors.forename: Pilar L
authors.initials: PL
authors.lastname: Rojas
authors.forename: Pilar S
authors.initials: PS
authors.lastname: Gómez De Liaño
authors.forename: Hideki M
authors.initials: HM
authors.lastname: Fukumitsu
authors.forename: Jacobo M
authors.initials: JM
authors.lastname: Yáñez
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004172:Diplopia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D009801:Oculomotor Muscles / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D020432:Trochlear Nerve Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A