Bilateral superior oblique muscle palsy associated with Apert's syndrome.

Eleven children had Apert's syndrome and bilateral superior oblique muscle palsy. Of seven patients who underwent surgical exploration of the superior oblique muscle area, five had no superior oblique tendon in either eye and two had only a small fibrous band as a remnant in each eye. All 11 patients had a significant horizontal deviation in primary gaze and downgaze, in addition to a vertical imbalance. The findings led to the conclusion that all patients with craniofacial anomalies, especially those with Apert's syndrome, should be examined for the presence of vertical muscle palsies and particularly bilateral superior oblique muscle palsy.