Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
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Case Reports
Superior oblique palsy in a patient with a history of perineural spread from a periorbital squamous cell carcinoma.
A 74-year-old man experienced vertical diplopia. Two years earlier, he was diagnosed with a squamous cell carcinoma of the periorbital frontal skin, with perineural spread involving the ophthalmic division of the right trigeminal nerve and the right facial nerve. The clinical findings were consistent with a right fourth cranial nerve palsy. ⋯ The authors believe this case to be the first report of superior oblique underaction due to involvement of the muscle by squamous cell carcinoma, presumably because of perineural spread. Diagnosis was made possible by neuroimaging and histopathology. There was good short-term resolution of the patient's diplopia after radiotherapy.