For one reason or another the fusion system breaks down and the deviation becomes manifest. There are tell tale signs that tell the sophisticated doctor that the turn has been there a long time and one does not have to worry about it such as a head tilt being present in old pictures, etc. If the hypertropia is a decompensation of a congenital deviation, then treatment may consist of prism glasses and vision therapy. Our goal is fusion without prismatic glasses. However, often time s treatment requires small amount of prism to hold the eyes in comfortable alignment.
Treatment is highly successful.
Surgery should be reserved for those cases that do not respond to vision therapy. However, if the deviation is newly acquired one must rule out serious neurological causes. Treatment, for newly acquired superior oblique palsies that do not resolve in 6 mos. In this case there is a poorer prognosis for complete repair. Newsletters are sent out less than five times a year.