1 Diagnosis of Isolated Cyclovertical Muscle Palsy

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Question : A person enters the OPD with Head tilted to left side and presents with Hypertropia in Right eye which increases on Left Gaze. Name the muscle paralysed ?

Answer :  Right Superior Oblique Palsy

Method to get to the answer


  • Please see that in the question Hypertropia is COMPENSATED with LEFT TILT , thus the tilt which will increase Hypertropia is RIGHT TILT (Hence for answer - EGT is RLR)

  • Diagnosis of Isolated Cyclovertical Muscle Palsy

  • Hypertropia More in (E,G,T)


EYE (E)
GAZE (G)
TILT (T)
 Method to remember
Answer

1.

R

L

R
More “R” , thus Right Muscle
R is Alternate/Opposite – So OBLIQUE

RSO
2.
L
R
L
Using L instead of R in above method
LSO







See the next 2 to understand where to put Superior


3.
L
L
L
When all Same then Muscle different , Therefore Now “R”
RIO
4.
R
R
R
Using above method
LIO







In exams “all Inferior Rankers are similar but the Superior Rankers are at good gap i.e different


5.
L
L
R
Ist two are same so Inferior , and since the opposites are not same so it is not oblique.
L more so muscle is Left
LIR
6.
R
R
L
Using the above method


RIR






7.
L
R
R
Last two are same , so we reverse the method above – thus now Superior Muscle.
And R is more so Right muscle
Also not opposite , so Rectus.
RSR
8.
R
L
L
Using method above
LSR


The above method might seem a little complicated but trust me , if you understand it then you would never get it wrong.

Summary
  • a.       EGT (order is must to remember)
  • b.      Remember that Hypertropia Increases on the sides mentioned i.e RLR means Hypertropia increases/present in Right Eye ,Left Gaze ,Right Tilt.
  • c.       More the L / R – same is the muscle Except if ALL SAME as in 3 , 4
  • d.      If Alternate / Opposite same – then Oblique
  • e.      If All same then it is Inferior (thus if opp same then Superior)
  • f.        If 1st two / last two same – then Rectus
  • g.       Ist two same – Inferior (thus if last 2 same - then Superior)

1 comment:

  1. WOW!!! I found it a bit confusing at start but seriously when i read it 2nd time and then applied the method - it worked like MAGIC.
    It just appears complicated but is damn useful. thanks :)

    ReplyDelete

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