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Eye Care (Expert Forum)
Traumatic Bilateral Trochlear Nerve Palsy
Our Ask A Doctor Ophthalmology Forum is where you can post your question and receive a personal answer from physicians affiliated with the American Academy of Ophthalmology.
Traumatic Bilateral Trochlear Nerve Palsy
by Chris__0__0, Jul 25, 1999 12:00AM
Posted by Chris on July 25, 1999 at 21:11:04
I am a 31 y/o male who acquired bilateral trochlear nerve palsy 2.5 years ago due to a sports related injury. I have adapted well to the vertical and horizontal diplopia, but was wondering what kinds of treatment options are available now (surgical, botox injections...) Also, could you give me any potential complications which may arise from said treatments. Thank you for your time.
Posted by HFHS MD - NI on July 27, 1999 at 19:50:05
Bilateral fourth nerve palsies are not uncommon after severe trauma. They may spontaneously improve and if so usually do within 3 - 6 months. The most common symptoms are double vision which may be treated with prisms. The problem is that it is difficult to eliminate the double vision in all directions of gaze. It sounds like you are doing fairly well. Other possible options are surgery to strengthen the superior oblique or to weaken its opposing muscle. If the double vision is not tolerable and if prisms do not help, this is probably the best option. There is always the possiblity of under or over correction which can still leave you with double vision. I do not think botulinum toxin is generally used for chronic fourth nerve palsies. However, I do not specialize in strabismus surgery. Given your problem, you should see a pediatric ophthalmologist who also does adult strabismus surgery. It is important to see someone with alot of experience in this particular area (bilateral 4th nerve palsies). If you do not have one locally, you can contact us at the Henry Ford Hospital by calling 1-800-363-7575.
Sincerely,
HFHS MD - NI
