Johnson

Emily Johnson
Barbara Presnell
UWRT 1103
28 October 2014
Superior Oblique Palsy
I have double vision. Unless I look straight ahead, I see everything in 2 different
dimensions. Heres how I know:
When I was about 13 years old, I went to the eye doctor to have an eye exam checkup. I
thought that I needed glasses because it was hard to see the board. At the checkup, I found out
that my right eye has 20/50 vision, was far-sighted, and had a stigmatism. My left eye, however
had 20/250 vision, and was near sighted. I thought that had to be the problem, so I got glasses
and started wearing them to class. After awhile, I noticed that the board got clearer, but it was
still hard for me to make out all the letters unless I shut one of my eyes. I went to another eye
specialist to get a second opinion. He asked me if I see double vision. Living with the same sight
your whole life, you never realize that something is wrong unless someone tells you otherwise. I
realized that unless I looked straight ahead, I saw everything double. In other words, for every
one thing you see, I see two of them in two different dimensions. He told me that I had right
superior oblique palsy. Which means that my right eye was higher than my left one. It was about
18 units higher. He put a prism in my glasses to help me correct it, and after that didnt work
very well, I decided to have surgery to fix it. In seventh grade, I had my surgery and everything
went as planned. My vision got a lot better and I could see a lot more of the board at school.
After a while, I noticed that I still saw double. I went to my doctor to see what went wrong. After
another look, he told me that I also have left superior oblique palsy. He didnt notice it because

Johnson

while my left eye is about 4 units higher than where it should be, my right was so much worse
that it was hard to catch. I decided not to have another surgery, because at this point, I knew how
to compensate my vision enough, and tilt my head just the right way. Another surgery would
have most likely fixed it, but I didnt think it was worth it to go through another surgery. Thats
right, Im stuck with double vision for the rest of my life, and having a condition like that really
made me wonder about it.
What is superior oblique palsy?
Superior oblique palsy, or SOP as I will abbreviate it as, is an eye disorder that occurs
when the superior oblique muscle becomes too loose. According to Superior Oblique Function,
Anatomy, & Diagram, this muscle, which starts at the nose and ends over the eye, controls
stability for the eye. It is in charge of making sure that the eye moves around the socket at the
right speed and with the right tension. Sometimes, this muscle either doesnt develop correctly
(like in my case), or it gets loosened by other problems which I will later mention, and doesnt
correct the eye movement. This causes an almost lazy eye effect, because the muscle isnt tight
enough to bring the eye down to where it needs to be to match with the other one. This would
explain why I see double of everything; my eyes look at the same image but from 2 different
perspectives so it gets the same view but from 2 different angles. The unequal tension in both of
the eyes is what leads to a person having SOP.
Diagnosing the Problem
When I went in to get a second opinion, my eye specialist gave me an eye test that was
kind of similar to the regular check-up kind of test that most people receive every time they go to
have their eyes checked. There were a lot of differences, like this one was a lot more in depth,
and required me to move my head around more, but it was still similar. Eventually he got to the

Johnson

part in the test where he held up a prism to my eye and watched for signs of SOP. When those no
longer manifested themselves, he knew that was the right sized prism for me, which also told
him how much correcting my eye needed to have done. Its pretty simple to diagnose SOP
because there are only a few factors that are dead giveaways. Since Ive been living with this for
so long, sometimes I can see peoples eyes and know that they have mild superior oblique palsy.
Im not a doctor though, so I might be wrong. At the 2014 Optometrys meeting, Debby
Feinberg, OD, and Mark S. Rosner, MD talked about the importance of screening for SOP. They
said that it was very important for eye specialists to do the right kinds of tests on people that
show signs of SOP in order to catch it early and decide what treatment options are best. As I
mentioned earlier, I used a prism on my glasses for a bit to try and correct my SOP. What I think
is interesting about this article is that Feinberg and Rosner claim to have invented the idea of
putting prisms in glasses for correctional purposes. They also claim to have developed something
called the Binocular Vision Dysfunction Questionnaire, which is basically just a lot of questions
asking about symptoms and side effects of possible eye problems that are used to help narrow
down a diagnosis. There is a version for adults and a version for children. Im guessing that
thats what was used for my diagnosis, but again, I could be wrong.
What does it look like?
Here are a few pictures that show what SOP eyes look like when they look in different
directions:

Johnson

(Google images, 2014)

Notice how when the eyes look in certain directions, they dont go to the same place, and it
creates a lazy-eye effect.
How does this happen and What are the side effects?
There are 3 ways in which SOP can occur in a person. They can be born with it like me,
they could have acquired it from some type of accident in which they experienced head trauma,
or it could have been brought on by other health complications such as aneurisms, There are
many side effects that people with SOP can experience. These are all explained in an article I
found titled Superior Oblique Palsy Workup and Classification. Most often, people usually
experience either vertical or torsional diploma, which are just fancy terms for what kind of
double vision the person is experiencing. I have vertical. People will often complain of
asthenopia, which is a fancy term for eye strain, head tilts, and facial asymmetry. These are the
most common symptoms, and although they are not directly dangerous, they can be very
annoying and can lead to physical distortion, such as chronic head tilt or eye misalignment.
How can this be fixed?
There are a couple ways to correct superior oblique palsy. The prisms, as mentioned
earlier, are the quickest, and least permanent fix. They go on glasses like a sticker and can be
worn around all day. I didnt like having a prism because it blurred my vision in the eye that it

Johnson

was on (even more than it was already blurred), and it was just a temporary fix. As soon as my
glasses came off, or I had to look beyond my glasses, the effects of the prism were gone. There
are a few types of surgery that can fix SOP as well. I dont know which kind of surgery I had,
but I know that it worked on the eye that I had it on. In 2001 an eye specialist at St. Pauls Eye
Unit in Royal Liverpool University Hospital completed a 17-year study that looked into the
technique of the eye surgery called Superior Oblique Tuck This surgery allowes the surgeon to
go underneath the eye and tuck the loose muscle behind the eye in hopes to strengthen the pull
force on the eye. This study showed that this surgery was 100% successful 71% of the time.
Most surgeries are very similar to this one, and involve having to basically tuck that loose
muscle back in order to tighten the eye up.
What happens if I dont fix my SOP?
Since my surgery, I have not had another problem with my right eye, however I still live
with it in the left eye. I have always wondered in the back of my head what would happen if I
never have any surgery done or any kind of corrective measures performed to fix it. Can I die?
Can I go blind? Will it ever fix itself? The answers were all on google, thankfully, and now I
know that there is no way that this problem will ever directly kill me. According to Dr. Toole,
the Clinical Assistant Professor of Optometry for the College of Optometry at the Ohio State
University, in my case, it is very likely that nothing will ever change for me. Since it hasnt fixed
itself already, it probably never will in the future, and the symptoms I have now will always be
here unless I get it fixed. However, if it goes untreated in a young child, it could result in having
a lazy eye, bad depth perception, and/or a head tilt.

Johnson

In Conclusion
So there it all is. Every question that I could think of is finally answered. Im glad to
know that this isnt a dangerous condition and that if I wanted to get it fixed, there were many
options out there for me. I now know pretty much everything there is to know about my eye
condition and I hope that I answered all of your questions too. Now that I know all about my
condition, I have actually started to notice it more and more. I actually need my glasses all the
time now, which is strange because before this research I didnt mind not having them. Its been
really eye opening (no pun intended) knowing all of these new things about myself. People used
to ask me questions about it and I would have to tell them that I really didnt know. It was sort of
a let down to have people asking me personal questions but me not even being able to answer
them; now I know so much and am able to share with everybody! I dont want people to feel bad
for me by any means, and I dont want people to pity me or anything; I did this research paper
for me, so that I could learn more about myself, and maybe educate more people on the subject.
Who knows, maybe one day someone with SOP that they dont know about will read this, go
have their eyes checked out, and realize they had the condition too! I think that would be the
most perfect end to my story.

Johnson

Works Cited
Durnian, J. M., and I. B. Marsh. "Superior Oblique Tuck: Its Success As A Single Muscle
Treatment For Selected Cases Of Superior Oblique Palsy." Strabismus (09273972) 19.4
(2011): 133-137. Academic Search Complete. Web. 21 Oct. 2014.

Frajerman, Chelsea, and Nancy Hemphill. "Speakers urge clinicians to screen patients for
binocular vision dysfunction." Primary Care Optometry News Aug. 2014: 16. Academic
Search Complete. Web. 21 Oct. 2014.

Healthline Editorial Team. "Superior Oblique." Superior Oblique Function, Anatomy &
Diagram. Healthline, July 2014. Web. 21 Oct. 2014.

Helveston, Eugene M., MD. "Superior Oblique Palsy Workup and Classification." Superior
Oblique Palsy Workup and Classification. Project Orbis International Inc., 2000. Web. 21
Oct. 2014.
"Images - Google Search." Images - Google Search. N.p., n.d. Web. 27 Oct. 2014.

Toole, Andrew J., OD, PhD, FAAO. "Eye and Vision Care." Ask an Expert: Superior Oblique
Palsy. The Ohio State University, 29 Mar. 2011. Web. 21 Oct. 2014.