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Eye and Vision Care

Fourth Nerve Palsy



My 45 year old husband was diagnosed yesterday with fourth nerve palsy that the opthoneurologist believes, as do we, was congenital based on multiple childhood pictures showing my husband`s compensatory head tilt. The neurologist gave us a referral to a surgeon and I`m hopeful that there might be another way i.e. vision therapy, to remediate this problem as I`ve read about post-surgical Brown`s syndrome and the need for multiple surgeries which raises my concerns. He was prescribed prism lenses that include a bifocal component that do seem to help, but when he`s tired he has a struggle getting the eyes to track properly. Thanks so much.


I do not know of any vision therapy that works in Brown's syndrome patients, and surgery at age 45 is usually not indicated because, as you stated, there can be multiple surgeries and complications.

If he is 45 and this is a congenital problem, I think most eye doctors would not advise any treatment in an attempt to regain binocular function at this stage of his life.

One possible treatment is monovision, where one eye is fit with a contact lens for distance vision and the other eye is fit with a different contact lens power for near vision. If this technique works, it would relieve the struggle of trying to get both eyes to focus simultaneously.

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Response by:

Robert D Newcomb, OD, MPH, FAAO Robert D Newcomb, OD, MPH, FAAO
Professor Emeritus of Clinical Optometry
College of Optometry
The Ohio State University