Could I possibly have superior oblique palsy?

[wishless]

I have been experiencing asthenopic symptoms for at least five years now, both at near and in the distance. It manifests as a constant strain in the back and middle of the head, that makes reading and paying attention in class difficult. When I do homework for my calculus class, I have to look from one point to another on the page frequently, which makes me dizzy. I've noticed that "relaxing" my eyes relieves this strain, but when I do that, my vision doubles. This double vision is diagonal, and a bit torsional.

I've seen two optometrists who noted hyperphoria in my right eye. But then I saw a strabismus specialist yesterday, and he gave me a Hess test, a measure of eye alignment. According to him, the Hess test came out pretty normal, and he couldn't see evidence of eye muscle dysfunction. I'm wondering if this was because the hyperphoria is latent?

I've been doing research on the potential cause and I'm wondering if I could have congenital superior oblique palsy in my right eye. The reason I'm considering this is because I've been having these symptoms for at least five years, my right eye is hyperphoric, and the double vision is a bit torsional. I don't really notice a nasal upshoot, but I do notice constant double vision if I look FAR to my left.

I'd appreciate any informed opinions on this, thanks.

[John C Hagan III, MD, FACS, FAAO]

With Jules Stein you are in good hands. Work through your problem with Dr. Demer.  You can pose your question next visit.

JCH MD

[wishless]

Yes, I saw Dr. Joseph Demer at Jules Stein Eye Institute. He seemed to have difficulty reconciling my account of symptoms with the test results, and came up with the explanation of dry eye. I've been using eye drops since the appointment to see if that was true, but they have not relieved my symptoms, so far at least.

"Its relatively certain you do not have congenital SOP or your symptoms would have been present all your life."

I thought it could become decompensated over time though? That the fusional mechanisms prevent you from experiencing symptoms until they decompensate in adulthood? Is that a possibility?

[John C Hagan III, MD, FACS, FAAO]

Its relatively certain you do not have congenital SOP or your symptoms would have been present all your life.

I have an exophoria with a torsional rotation that bothers me when I am extremely tired. Was the strabismus specialist an Eye MD ophthalmologist? If so you would have had a dilated cycloplegic refraction to determine how much latent hyperopia you have.  If small amount not usually a problem. IF large amount you may need reading/computer glasses or even glasses all of the time.

If you did not see an Eye MD strabismus specialist get in to see one. Find one at www.geteyesmart.org

JCH MD