I am new to this forum and this is my first post. My 9 yo DD has been diagnosed w/4th cranial nerve palsey and has been recommended for surgery by the ped opthalmologist.

Because of her amplitude, the problem is barely noticeable in terms of misaligned eyes (unless in a downward left gaze--and then only slightly). We first noticed something unusual when she was about 4, and took her in for an eye exam where she was told to "let it go" and if it worsens come back. There were a few times in her childhood that she complained of double vision, but until recently (with more reading required in 4th grade) had really never had any vision problems. She does not currently have amblyopia and thankfully has great vision--20/25--in both eyes.

I would love to hear of anyone's experience with 4th nerve palseys and especially anyone's experience with eye muscle surgery to correct it. We are concerned about negative results (as her vision is great now), repeat surgeries, and whether myopics or other types of treatments/therapies have been useful for this condition.

Thanks in advance for your replies. Dad23

Hi: This sounds like a case where you could benefit from another opinion. The AAPOS website has a list of their trained and certified POs in all locations.

Torre

Thanks Torre. I take it you believe that not all, or even the greater majority of PO's would recommend surgery for a 9 yo with congenital 4NP?

Our dilemma is that we are concerned about negative outcomes from surgery, that is making the somewhat tolerable condition worse. I can't help thinking that the more mild the symptoms are, the greater the chance (however small) of making the condition worse with surgery. But as of yet I've failed to find much information on any other effective treatment of congenital 4NP.

Our PO is a member of AAPOS and a very respected eye muscle surgeon specializing in childhood strabismus surgery. When we asked about other treatment options, the only thing he didn't completely dismiss was prism glasses but said that because of the fact that her misalignment occurs at very specific gazes he didn't think they would be practical (or even possible to grind).

Our choices seem to be to either do nothing or have the surgery, so I am curious to hear if anyone has had experience with 4th nerve palsy and if so what did they do about it (if anything)?

I can't offer any help. Sounds like your daughter has a good doctor, but it never hurts to get a second opinion.

T.

I can't offer any help either except to tell you that my baby brother had repeated surgery on one of his eyes and his eye problem never straightened out. My parents had faith in their doctor but they were really sorry that they didn't get a second opinion........my little brother was sorry too. I don't remember what problem he had
other than his eyes being crossed and his vision being bad of course. I agree with Torre. It wouldn"t hurt to get a second opinion.
Hope all turns out great for your daughter. Good Luck - God Bless and hugs Karen