Aquired Unilateral Fourth Nerve (Superior Oblique) Palsy

Hello,

I am a 36 yo male who was diagnosed with isolated 4th nerve palsy on Dec 8th.

Let me begin with brief background:

I am very healthy, ideal weight (160lbs), eat right and exercise regularly, no drug abuse, non-smoker. I have had no surgeries or past medical issues other than treatment for ADD/depression/anxiety problems. No new medications. Regular eye checkups have been excellent and I have 20/20 vision. No head/eye trauma or accidents.

I started noticing some intermittent diplopia in September this year. I developed a mild sinus infection in mid October (treated with antib's and cleared) and the double vision became bothersome, especially in downward and left gaze. The 4th nerve palsy is unilateral and in my right eye. My girlfriend told me I tilt my head left, squint and glare my eyes often, esp. when I am reading (i.e. a menu at a restaurant). It seems that my right eye will "wander" as I turn my head (eye seems slow moving). It might take about a second for the images to converge when looking straight ahead. This is very disorienting and I am becoming very distressed by this. What if this gets worse and I can't drive?

Last week I had an MRI and there were no tumors, stroke, aneurysm or any signs of MS (though I understand that 4th nerve palsy is a rare symptom of MS). Blood test revealed no sign of diabetes and my blood pressure was taken throughout the day - normal. The ophthalmologist did many tests and my eyes are healthy, pupil responses good, visual acuity excellent, retina normal, etc. He also ruled out M Gravis and some other diseases. He does not yet have an answer for me, but I have another appointment in a month (very hard to get an appoint with him).

What could be causing this all of the sudden? Could this be a congenital defect that only just started manifesting itself? Has anyone else had this kind of problem with no explanation?

Feedback would be appreciated :)

Thanks!
Daniel

[John C Hagan III, MD, FACS, FAAO]

Daniel
    Many 4th nerves paresis are "idiopathic" meaning we do not know what causes them. Know that sinus disease if severe can cause the problem.
    Go to e medicine and read the section of 4th cranial nerve paralysis if you want to know more. Most clear by themselves. If it doesn't clear over 6 months some can be helped with surgery.  

JCH MD

[Drake701]

I have the same unexplained symptoms although it is in my left eye. Same situation perfect weight, very good health other than some muscle weakness & soreness probably because I don't work out as I should.
I am quite a bit older than you & female, I am not on any medications.
This is effecting my driving & I have been only driving when I have to, night driving is out as they gave me mono-vision contacts & that creates halos around all lights.
I was wearing multifocal lens before I started seeing the doctors for this problem, they seem to think strengthing the muscle will help.
I will tell you that a new symptom just develpoed & that is very mild numbness on my left side of my face near my cheek bone.
That concerned the Opthalmologist & he is now send me to a nero-Opthalmologist.
I also had an MRI & it was normal.
This is a very strange situation.
Good Luck with yours I wish you well.

[John C Hagan III, MD, FACS, FAAO]

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