superior oblique muscle    n. A muscle with origin above the medial margin of the optic canal, with insertion by a tendon passing through the trochlea to the sclera between the superior rectus and lateral rectus muscles, with nerve supply from the trochlear nerve, and whose action directs the pupil of the eye downward and outward.     "superior oblique muscle." The American Heritage Stedman's Medical Dictionary. Houghton Mifflin Company, 2002. Answers.com GuruNet Corp. 07 Jul. 2005. http://www.answers.com/topic/superior-oblique-muscle superior oblique muscle   The superior oblique muscle is a muscle in the orbit that causes the eye to look downwards when it is already directed medially (looking towards the nose).  It is the only muscle supplied by the trochlear nerve. The superior oblique loops through a pulley like structure (the trochlea) to get the desired movement.     "superior oblique muscle." Wikipedia. Wikipedia, 2005. Answers.com GuruNet Corp. 07 Jul. 2005. http://www.answers.com/topic/superior-oblique-muscle Here are SOM related links to abstracts, articles and other citations of material that are informative. Please share these references with your doctor.  It is important to note that these resources are here only because the sources have been generous in giving us permission to link to the information.  Many resources do not allow us to link directly to the document, but permit a link to their main/home page.  In those cases, instructions will accompany the link information.  For those of us with dial-up connections, this can certainly be more work, but it cannot be avoided. Name of the source, as well as Volume, Issue and page numbers are included so that you will be able to find the information even if (most likely 'when') the journal revamps their website and the link stops working.  General Information regarding SOM To begin, we have long needed a description of diplopia and head tilt.  I should have provided this sooner, but finally found what I thought was the most informative and most easily understood articles.  So, without further ado...here they are! Diplopia eMedicine/WEBMD September, 2008 Author: Izak F Wessels, MB, BCh, MMed, FRCSE, FRCO, BSc, FACS, Associate Professor, Department of Ophthalmology, Chattanooga Unit, University of Tennessee College of Medicine; Private Practice in Comprehensive and Surgical Ophthalmology, Allied Eye Associates http://www.emedicine.com/oph/topic191.htm Head Tilt JAAPOS February 2004 Volume 8, Issue 1, Pages 1-12 Ocular torsion: rotations around the “WHY�?axis Presented as the Costenbader Lecture at the 29th Annual Scientific Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Kamuela, Hawaii, March 24, 2003. Dr. Burton Kushner http://www.journals.elsevierhealth.com/periodicals/ympa/article/S1091-8531(03)00262-3/abstract The Clinical Manifestations, Natural History and Results of Treatment of Superior Oblique Myokymia American Orthoptic Journal 1996 Dr. Neil R. Miller Board of Regents of the U. of WI system http://www.aoj.org/abstracts/46/46_185.html  Recurrent superior oblique myokymia in a patient with retinitis pigmentosa Optometrists Association Australia Revised 11-24-03 Robert Webster BOptom (UNSW) Stephen Leslie BOptom (UNSW) The second page of this PDF document has a really good description of SOM. http://www.optometrists.asn.au/ceo/backissues/vol87/no2/2858  Superior Oblique Myokymia Cyber-Sight Project Orbis International, Inc. This site allows linking to only their home page. http://telemedicine.orbis.org/bins/home.asp On the home page, use the search function (upper left) and type in superior oblique myokymia. The next page will have four (4) linked results.  The best, for our purposes, is the fourth one, titled, "Overaction of the Obliques." Part of their lecture series.  Excellent diagrams and descriptions.Authors and adjunct staff listed at bottom of the document.  Microvascular decompression for superior oblique myokymia: first experience Journal of Neurosurgery 1999,  August, Volume 91, Number 2, Pages 349-51. Drs. M. Samii S. K. Rosahl G. A. Carvalho T. Krizizok Nordstadt HospitalHannover, Germany This is the abstract that caught my interest in 2000.  It has been archived and is in a place difficult to access, so here is the NIH Pubmed location. http://www.ncbi.nlm.nih.gov/pubmed/9833830  Superior oblique myokymia associated with a posterior fossa tumor:oculographic correlation with an idiopathic case Neurology, 1990, Volume 40, Page 367 Drs. Mark J. Morrow James A. Sharpe Paul J. Ranalli Ontario, Canada http://www.neurology.org/cgi/content/abstract/40/2/367 Trochlear Nerve Palsy eMedicine/WebMD Original location unknown Drs. Zarar A. Sheik Kelly A. Hutcheson Excellent resource for information on the trochlear nerve.  A must read for everyone. http://www.emedicine.com/oph/TOPIC697.HTM Treatment of abnormal eye movements that impair vision: Strategies based on current concepts of physiology and pharmacology Annals of Neurology Volume 36, Issue 2, Date: August 1994, Pages: 129-141 Drs.: R. John Leigh Lea Averbuch-Heller Robert L. Tomsak Bernd F. Remler Stacy S. Yaniglos Louis F. Dell'Osso Mentions the use of botulinum toxin injections, meds and surgery.  Sure would like to have a copy of the full text. http://www3.interscience.wiley.com/cgi-bin/abstract/109680368/ABSTRACT Brief Communications and Case Reports Superior oblique myokymia Annals of Neurology July 26, 1982 Volume 13, Issue 6, Pages 667-669 Drs.: Michael L. Rosenberg Joel S. Glaser Basic, anectodal information. http://www3.interscience.wiley.com/cgi-bin/abstract/109674218/ABSTRACT Superior oblique myokymia.  Quantative characteristics of the eye movements in threee patients Journal of the American Medical Association Archives of Ophthalmology December, 199, Volume 109, Number 12 Drs. R.J. Leigh, R.L. Tomsak, S.H. Seidman, L.F. Dell'Osso http://archopht.ama-assn.org/cgi/content/abstract/109/12/1710 Binocular Vertical Diplopia Mayo Clinic Proceedings Drs.: paul W. Brazis Andrew G. Lee Quite amazing information regarding evaluation and description.  SOM is nearly halfway down the page.  Great references 35-52. http://www.mayoclinicproceedings.com/inside.asp?AID=2829&UID=