Case Report: Using Horizontal Vergence HomeTherapy to Treat Decompensated 4th Nerve PalsyCaused by SSRI Use

Background Patients with congenital fourth nerve (trochlear) palsies may present as asymptomatic, until an etiological event such as starting a new medication may cause decompensation. Symptomatic fourth nerve palsies will present with vertical diplopia, worse in contralateral gaze and ipsilateral head tilt, therefore may result in an adaptative contralateral head tilt. Treatment for fourth nerve palsies can include vertical prism, but also can be effectively treated with vision therapy.