Unilateral Superior Oblique Palsies (Illustrated for Right SOP)

Class R.Hyper R.gaze SOUA IOOA Treatment
1 <15 None 0 to -1 +2 to +3 RIOc
2 <15 None -1 to -2 +3 to +4 RIOc vs myectomy
3a <15 None -2 to -4 0 to +1 LIRc
3b <15 As 3a but with sig torsion RSOt or Harada Ito + LIRc
4 >15 Sig. 0 to -2 +3 to +4 RIOc + RSRc
5 >15 Sig. -2 to -3 0 to +2 RIOc + LIRc
6 >30 Sig. >15 -2 to -3 +3 to +4 RIOc + LSRc & LIRc
7a <15 With spread of commitance RSRc
7b >15 With spread of commitance RSRc + RIRs or LIRc
8 <20 Fallen eye syndrome LIRc

SOP: Superior Oblique Palsy
Sig: significant
SOUA: Superior oblique underaction
IOOA: Inferior oblique overaction
Treatment: Suggested treatment
RIOc: Right Inferior Oblique recessions or other weakening procedure
RSOt: Right Superior Oblique Tuck
LIRc: Left Inferior rectus recession
LSRc: Left Superior rectus recession
RSRc
: Right Superior rectus recession
RIRs: Right Inferior rectus resection

Based on Scott WE, Kraft SP, Classification and Treatment of Superior Oblique Palsies:I. Unilateral Superior Oblique Palsies. Transactions of the New Orleans Academy of Ophthalmology. 1986: 15-38.