An Alternative Surgical Treatment of Torsional Diplopia Secondary to Bilateral Superior Oblique Palsy

Torsional diplopia causes significant visual disturbance for patients with bilateral superior oblique palsies and often poses a surgical challenge. The Harada-Ito procedure may address the excyclotorsion by inducing an intorsion effect from transposition of the anterior superior oblique tendon fibers, however this procedure may be technically challenging, may induce a Brown syndrome and may not address the associated V-pattern esotropia. We present a case of a patient with severe torsional diplopia secondary to a bilateral superior oblique palsy that resolved with a bilateral inferior rectus recession with nasal transposition.