Superior oblique paresis following endoscopic brow lift

Abstract

Endoscopic brow lift (EBL) surgery, performed for cosmetic purposes, carries a small risk for postoperative superior oblique paresis leading to diplopia. We report 2 cases of diplopia after EBL. In the first, a 54-year-old woman was diagnosed with right eye superior oblique paresis, which was confirmed on magnetic resonance imaging (MRI), which revealed trochlear region enhancement. In the second case, magnetic resonance imaging revealed trochlear edema in a 24-year-old woman with similar superior oblique paresis symptoms. In the context of limited orbital imaging, superior oblique paresis after EBL likely results from trochlear displacement due to periosteal dissection. Notable is the spontaneous resolution of symptoms in both cases within 3 months, attributed to reduction of edema. This complication is linked to subperiosteal fluid accumulation or inflammatory processes near the trochlea rather than direct trochlear damage. These cases suggest that EBL-related superior oblique paresis may be self-correcting as edema subsides.