Bilateral Superior Oblique Palsies
| Class | HT | V | IOOA | SOUA | Torsion | DMR | AHP | Treatment |
| 1 | No | 22 | > +2 | -1 or 0 | No | 10° | No | BIOc |
| 2 | No | 16 | 0 to +1 | > -2 | Yes | 13° | Chin Down | BSOt or Harata-Ito |
| 3 | No | 40 | > +2 | > -2 | Yes | 14° | Chin Down | BIOc & BSOt or Harata-Ito* |
| 4a | Yes | 21 | >+2 Asym | > -2 | Yes | 14° | Tilt | Bilat. Harata-Ito or SOt and Unilateral IOc |
| 4b | Yes | 20 | +1 to +2 | > -2 Asym | Yes | 12° | Tilt | BSOt or Harata-Ito & IRc or SRc ± BIOc |
| 4c | Yes | 22 | > +2 Asym | > -2 Asym | Yes | 15° | Tilt | BIOc & BSOt or Harata-Ito & IRc or SRc |
| 5** | Yes | 10 | > +2 Unilat | -1 to -3 Unilat | No | 6°-11° | Tilt | Unilat IOc ± IRc brings out contralateral SOP |
HT: Hypertropia in primary gaze
V: mean amount of V pattern present in upgaze/downgaze
IOOA: Inferior oblique over action
SOUA: Superior oblique under action
Torsion: Subjective torsion
DMR: Average torsion on Double Maddox Rod test
AHP: Abnormal head position
Treatment: Suggested treatment
BIOc: Bilateral Inferior Oblique recessions or other weakening procedure
BSO Tuck: Bilateral Superior Oblique Tuck
IRc: Inferior rectus recession
SRc: Superior rectus recession
Asym: Asymmetrical under or over action
Unilat: Unilateral
SOP: Superior Oblique Palsy
* For class 3 patients: consider Bilateral Medial Rectus Recessions for Esodeviation
> 8 diopters
** Masked Bilateral Superior Oblique Palsy (9-16% of all Bilateral Superior Oblique
palsies)
Based on Scott WE, Kraft SP, Classification and Treatment of Superior Oblique Palsies:II. Bilateral Superior Oblique Palsies. Transactions of the New Orleans Academy of Ophthalmology. 1986: 265-91.