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Fourth Nerve Palsy
In this video, we see the eye movements of a patient with a fourth cranial nerve palsy.
The fourth cranial nerve innovates the Superior Oblique (SO) Extraocular Muscle.
The SO muscle depresses, intorts (incyclotorsion) and abducts.
Therefore:
- The eyes would sit straight or with a vertical misalignment.
- When taken into laevodepression, an underaction of the SO muscle would be seen.
- Other muscles will compensate for this imbalance and over/underact according to Herring’s and Sherrington’s Laws. This is called a muscle sequelae.
Causes of a 4th Nerve Palsy:
- Congenital
- Trauma (whiplash)
- Vascular disease
- Aneurysm or tumour (less common)
- Stroke
‘See also’ below the eye movements recorded by an Orthoptist in a right fourth nerve palsy. Note the sequelae.
This article is from the online course:
Orthoptics: How to be a Brilliant Allied Health Professional
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This article is from the free online
Orthoptics: How to be a Brilliant Allied Health Professional
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