Diagnosis of Isolated Cyclovertical Muscle Palsy

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 1^st two / last two same – then Rectus
• g.       Ist two same – Inferior (thus if last 2 same - then Superior)