ABSTRACT
The thyroid ophtalmopathy may sometimes present as an imbalance of oculomotor muscles. The aim of this study is to investigate the cases that manifest as a paralysis of the superior oblique and to bring an approach to pathogenesis. This study included 7 cases with thyroid ophtalmopathy imitating paralysis of the superior oblique and giving the anamnesis relevant with the signs or symptoms of Graves disease. All the patients showed binocular vertical diplopia at primary position and a paralysis of the superior oblique. Among all our patients showing a binocular vertical diplopia and with an anamnesis which was not compatible with the paralysis of the 4th nerve, we observed a hypertropia of 4 to 26 PD and an upshoot in adduction in the same eye. An excyclotorsion less than 10° was observed in 3 of 7cases. This clinical picture can be interpreted as a transformation of the previously asymptomatic paralysis of superior oblique into symptomatic state as a result of a decrease of fusion due to Graves disease.
