This 50-year-old female presents with difficulty reading and notes that her right eye feels "off." What exam findings would you expect?
Analysis
Here, we see a patient with a monocular, high frequency, low-amplitude, torsional contraction of the superior oblique muscle in the right eye (see video). This patient was diagnosed with a superior oblique myokymia, which is a twitching or spasm of the superior oblique muscle.
Many patients will report episodic oscillopsia or diplopia, but some may have milder non-specific symptoms like our patient. First-line therapy is topical beta-blockers.
In this 10-minute video featuring Dr. Paul Freund, Assistant Professor at Dalhousie University in Halifax, you will learn:
- How to identify a superior oblique myokymia
- Reasons to pursue neurologic work-up for superior oblique myokymia
- Management of superior oblique myokymia
Neuro Coach Tip
Superior oblique myokymia is always unilateral; bilateral torsional nystagmus requires nystagmus evaluation.
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