Trochlear nerve palsy

Causes: The commonest cause is trauma; less common causes include vascular disease (diabetes mellitus, hypertension, and arteriosclerosis). Trochlear nerve palsy is a relatively common phenomenon.

Effects: The superior oblique is primarily an intorter and a depressor in adduction. This results in upward vertical deviation of the paralyzed eye in adduction and vertical strabismus (see Fig. 17.16). Patients experience vertical diplopia; the images are farthest apart in depression and intorsion. Compensatory head posture is discussed in the section on symptoms. Diplopia is absent in elevation.

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