INTERMITTENT SUPERIOR-OBLIQUE TENDON-SHEATH SYNDROME

The signs and symptoms of the superioroblique tendon-sheath syndrome include (1) limitation of elevation in adduction with apparent paresis of the inferior oblique; (2) little, if any, overaction of the ipsilateral superior oblique; (3) elevation of the affected eye gradually increases from the adducted position to the point at which it is nearly normal in the midline; (4) nearly normal muscle balance in the abducted position; (5) widening of the palpebral fissure in adduction; (6) positive forced duction test; (7) variable degree of vertical deviation in the primary position; (8) head-turn; (9) pulling sensation or some form of discomfort in the area of the trochlea. It is assumed that the mechanical limitation is due to a structural anomaly in the sheath of the superior oblique. The case presented showed the typical clinical picture of this syndrome. After gentle pressure over the trochlea or after repeated attempts to elevate in the field of action of the affected muscle, full superior-oblique function was noted. A ball-and-valve mechanism is postulated as a basis for the intermittent findings. © 1969.