Fourth Nerve (Superior Oblique) Palsy

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WHAT IS A FOURTH NERVE weakness (PALSY)?

Fourth nerve weakness happens when the nerve in the brain that controls a certain eye muscle (the superior oblique muscle) is not working well. This can make the eyes not line up right. Often, one eye looks higher than the other. Sometimes it affects one eye, but it can affect both eyes too.

WHAT ARE THE SignS OF FOURTH NERVE OR SUPERIOR OBLIQUE weakness (PALSY)?

Some people with fourth nerve weakness get double vision. Sometimes people will tilt their head to make the double vision better. Kids with this issue might not see double, but they may still tilt their head to help their eyes line up better. As they grow, kids may tilt their head more. Some people are born with this problem but they might not notice it until they're older.

WHAT CAUSES SUPERIOR OBLIQUE or fourth nerve weakness?

People can be born with this problem or get it later in life. If they're born with it, its because the muscle or nerve did not grow normally. If it happens later, the fourth nerve weakness might be from a head injury (like in a car crash) or from other health problems like a stroke or brain tumor. Your doctor may do tests if they are not sure what is causing a fourth nerve weakness.

HOW IS SUPERIOR OBLIQUE or Fourth Nerve weakness TREATED?

For people born with a fourth nerve weakness, regular eye check-ups are needed to check for head tilt and weak vision. Some people don't need treatments for a fourth nerve weakness. Other people might need eye muscle surgery.

For people who get the fourth nerve weakness later in life, doctors first try to fix what caused the nerve weakness and see if it gets better. If the nerve weakness lasts more than six months, eye muscle surgery might be needed. Eye muscle surgery helps how the eyes line up, double vision and how people hold their head. 

Updated 08/2024


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