Superior Oblique Myokymia (Photo)

This photograph is of an eye suffering from superior oblique myokymia. This condition occurs when the 4th nerve is irritated (cause unknown) leading to a spastic contracture of the trochleur muscle. This causes the eye to intort/extort in a random fashion. This movement is extreamly frustrating for the patient as the earth seems to twitch in that eye. Treatment, however, is difficult as you don’t want to denervate and create a 4th nerve palsy and create diplopia.

This photograph is static, so there really aren’t any findings to comment on here. However, if you watch the superior oblique myokymia video from which this snapshot was taken, you can see the subtle ryhthmic twisting motion this eye undergoes. You can’t always see this with the naked eye, but if you look at a conjunctival vessel under the microscope, you can see that the whole eye is moving.