Superior oblique palsy or paresis in pediatric patients

Purpose To examine sensory and motor outcomes of superior oblique paresis (SOP) presenting in patients < 8 years old and to ascertain whether SOP was ever the presenting manifestation of intracranial pathology. Methods Retrospective observational case series of SOP in children < 8 years old in an outpatient university center. Results Ninety-two patients with SOP presented at a median age of 3.9 years. The etiologies were likely congenital (n = 56), craniofacial anomalies (n = 12), head trauma (n = 5), postresection of brain tumors (n = 3), orbital inflammation (n = 1), prenatal stroke (n = 1), and unknown (n = 14). Twenty-six were followed-up for a median of 2.1 years and did not have surgery; 46 were followed-up for a median of 3 years and did undergo surgery. No cases of new intracranial pathology occurred during follow-up. In 42 patients observed for at least 6 months without surgery, motor status was stable or improved (each in approximately one third of cases) or deteriorated (in one fourth of cases). Motor outcomes were better (P = .01) in patients undergoing surgery (87% aligned within 5 prism diopters) than in those not undergoing surgery despite worse presenting deviations. Sensory status did not show a similar improvement with surgery. Patients presenting before age 4 had worse sensory outcomes (P = .00001) than patients presenting later. At the last examination, 4 patients had vision < 20/40 from amblyopia. Conclusions SOP in children < 8 years old was not associated with the development of new intracranial pathology. Motor alignment and sensory function were often stable, although some patients improved, and others deteriorated. With surgery, satisfactory motor outcomes were usually achieved, but sensory status often was not improved. Sensory outcomes were generally worse in patients presenting at younger ages.