Q. I have a 4th nerve palsy issue and it scares me. Please help.

Answered by
Dr. Manjunath Natarajan
and medically reviewed by Dr.Nithila A
Published on May 31, 2019

Hello doctor,

I am a 58-year-old cyclist. I recently started having a strange problem with my vision that started almost a month ago. It was also around the same time I was getting new glasses, but my optometrist said that he does not think the two are related. He referred me to see a neuro-ophthalmologist, and it looks like I have a 4th nerve palsy issue. After reading about it, it is familiar to my recent experiences.

No accidents, history of diabetes or other issues. It seems to be my right eye. Looking straight, left and up is fine. The problem comes when looking down (bifocals) or looking right. I also read that blood flow could be an issue. I have been using my inversion table lately more often. I do feel obvious pressure in my eyes using this. Is that an issue? It scares me now, so I put it in the garage. I read this can be idiopathic and can even go away in a few months. Is it true?

Dr. Manjunath Natarajan

Ophthalmology (Eye Care)


Welcome to icliniq.com.

The symptoms you are experiencing can all be in 4th nerve or superior oblique muscle palsy. This muscle acts to stabilize the eye when looking down and is the primary muscle acting while looking down and outwards. Since you mentioned that you do not have diabetes or other systemic illnesses, the cause could be idiopathic. Such idiopathic nerve palsies do have a good chance of improving on their own. The best sign to look for improvement is to see the double images moving closer to each other, and eventually disappear, on the complete resolution. In case you have any further questions or want any additional information, please let me know.

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