| Of the several types of vertical strabismus, congenital or acquired superior oblique palsy is far and away the most common. | |
| 61. | These children present with a vertical misalignment of one eye as seen on image 61 where this child manifests a left hypertropia. |
| 62. | The deviation increases in gaze to the opposite side and... |
| 63. | on head tilt to the same side. |
| 64. | shows a child with a congenital left superior oblique palsy and a large left hypertropia in primary position. |
| 65. | The deviation increases dramatically on tilting the head to the same side, and... |
| 66. | improves or may disappear on tilt to the opposite side. For this reason these children characteristically present with a significant tilt of their head to maintain fusion and binocularity and any child with a significant head tilt should be seen by an ophthalmologist to rule out a paresis of one of the cyclovertical extraocular muscles. |