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—I would like to thank Christmann and Wolin for their comments regarding our recent article. They correctly point out that one of the most common causes of a superior oblique palsy is a breakdown of a preexisting vertical phoria from a congenital palsy. Of course, probably the most common cause is trauma (such as that produced from ligation of the anterior ethmoidal artery). Specifically, however, no measurements of vertical fusional amplitudes were done. These patients were referred by otolaryngologists and this testing was not possible. Review of old photographs did not show any head tilt position; review of cover testing in the diagnostic positions of gaze did not reveal any spread of concomitance. In addition, both patients noted the sudden onset of excyclotorsion, as measured with double Maddox rod testing, which would not be expected in a congenital case.Concerning case 2, the patient was examined 3 weeks,
Somers ME. Superior Oblique Palsy as a Complication of Anterior Ethmoidal Artery Ligation?-Reply. Arch Ophthalmol. 1991;109(6):767. doi:10.1001/archopht.1991.01080060021008