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Patient shown preoperatively with right superior oblique palsy which measured
30 prism diopters in the primary position

For several months after surgery the patient enjoyed comfortable, single binocular vision

By the eighth month postoperatively the patient demonstrated left hypertropia and bothersome vertical diplopia

This 52-year-old woman underwent right inferior oblique myectomy and left inferior rectus recession for a large, symptomatic right superior oblique palsy.  She enjoyed comfortable single binocular vision for several months after surgery.  By the eighth month postoperatively she was noted to have 10 prism diopters of left hypertropia and complained of bother vertical diplopia.

1.	The original surgery was:
	a. designed correctly b. excessive c. done on the wrong muscles d.  none of the above
2.	The most likely cause for the left hyperdeviation is:
	a. dissociated vertical deviation, left eye b. left superior rectus contracture c. slipped left inferior rectus d.  right inferior oblique adherence
3.	The best treatment for this condition would be:
	a. right superior oblique tenectomy b. left inferior rectus advancement and resection c. left superior rectus recession d.  Botox to the right superior rectus

For answers to the above, click here on or after December 28, 2004.