What are the possible complications of trochlear nerve palsy (fourth nerve palsy) surgery?

Updated: Oct 08, 2019
  • Author: Zafar A Sheik, MD, MD; Chief Editor: Andrew G Lee, MD  more...
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As with any strabismus surgery, undercorrections and overcorrections may occur. It is generally better to undercorrect a patient than to overcorrect a patient.

For patients with long-standing disease and large fusional amplitudes, a small residual deviation may be perfectly well controlled, but an overcorrection will be intolerable.

Adjustable suture surgery minimizes risk of overcorrection and undercorrection.

Perhaps the most troublesome complication is that of iatrogenic Brown syndrome, resulting in severe limitation of elevation. [38] Assessing superior oblique tendon intraoperatively should make this less likely.

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