How are torsional symptoms treated following surgery for trochlear nerve palsy (fourth nerve palsy)?

Updated: Oct 08, 2019
  • Author: Zafar A Sheik, MD, MD; Chief Editor: Andrew G Lee, MD  more...
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Patients with torsional complaints are among the most difficult to treat. Considerations are as follows:

  • In general, patients can fuse up to about 8° of cyclotropia before becoming symptomatic.

  • Patients with bilateral fourth nerve palsies from head trauma should be warned about the likelihood of persistent diplopia after surgery.

  • Many of these patients also may have central disruption of trauma from severe head injury and will be unable to fuse even after excellent surgical alignment.

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