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Case Report

Two cases of fourth nerve palsy in pregnancy


Amrit Sehmi ,

Orthoptic Department, Moorfields Eye Hospital NHS Foundation Trust, London
About Amrit
BMedSci (Hons)
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Jamil Hakim,

Ophthalmology Department, Kings College London NHS Foundation Trust, London
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G.G.W. Adams

Ophthalmology Department, Moorfields Eye Hospital NHS Foundation Trust, London
About G.G.W.
FRCS (Ed) FRCOphth
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Aim: To present two cases of recent-onset fourth nerve palsies during pregnancy.

Methods: Two pregnant patients presented to A&E with recent-onset diplopia due to isolated right superior oblique palsy. Patient 1, aged 42, complained of a 5-day history of intermittent vertical diplopia at 38 weeks gestation. Patient 2, aged 34, presented with constant horizontal and vertical diplopia at 34 weeks gestation.

Results: Two months after giving birth, patient 1 attended the eye clinic reporting her symptoms had completely resolved within 5 days from onset. Patient 2 reported her symptoms resolved within 3 months. Both patients fully recovered, therefore no further management or investigation was required. They both gave birth at term without complication. Patient 1 presented with a slight hyperphoria in primary position, demonstrating binocular single vision (BSV). Ocular motility and Hess chart showed a very slight right superior oblique under-action. Her blood pressure, fundus and media were normal and no underlying pathology was found. No further investigations were undertaken. Patient 2 presented with a slight exotropia and right hypertropia in primary position, with diplopia and no BSV demonstrable. Further orthoptic testing showed right superior oblique under-action. No pathology was found.

Conclusions: Cranial nerve palsies developing in pregnancy are rare but have been reported. No pathology was found in our cases; however, the literature does suggest that serious cases could be apparent and should therefore be considered.

How to Cite: Sehmi, A., Hakim, J. and Adams, G.G.W., 2016. Two cases of fourth nerve palsy in pregnancy. British and Irish Orthoptic Journal, 13, pp.48–51. DOI:
Published on 01 Aug 2016.
Peer Reviewed


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