To the Editor.
—We were interested in the article by Couch and colleagues1 in the August 1990 issue of the Archives since we had recently encountered a similar case. A 35-year-old man underwent arterial ligation to control right-sided posterior epistaxis. The internal maxillary artery and its infraorbital branch were ligated within the pterygopalatine region via a transantral approach, and the anterior and posterior ethmoidal arteries were ligated via a nasofrontal approach. As his right lid swelling resolved, allowing binocular vision, the patient noted vertical diplopia that improved when he tilted his head to the left. He had a 1-prism diopter (PD) right hypertropia (RHT) in forward gaze, a 3-PD RHT in left gaze, a 1-PD RHT in right gaze, a 3-PD RHT in right head tilt, and a 1-PD RHT in left head tilt. Subjective Maddox rod testing confirmed a motility disturbance consistent with a right-sided superior oblique palsy.
Jacobson DM, Pesicka GA. Transient Superior Oblique Palsy Following Arterial Ligation for Epistaxis. Arch Ophthalmol. 1991;109(3):320-321. doi:10.1001/archopht.1991.01080030022017