Superior oblique myokymia (Video)

This video shows an eye suffering from superior oblique myokymia. This occurs when the superior oblique muscle rhythmically fires, causing a twitching intorsion of the eye. This is a difficult finding to pick up by simple external examination alone, as the twitching is subtle. Under the microscope, however, you can see the eye intorting. The key is to examine the conjunctival vessels as they move rhythmically.

These patients present with a lot of discomfort from oscillopsia and treatment is challenging in my experience. Typically involves medical therapy as surgery isn’t terribly helpful and can cause significant diplopia afterwards.

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Superior oblique myokymia
This photograph is of an eye suffering from superior oblique myokymia. This condition occurs when the 4th nerve is irritated (cause unknown) leading to a spastic contracture of the trochleur muscle. This causes the eye to intort/extort in a random fashion.

Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:


  1. how we can differentiate from rotary nystagmus?

    Rotary nystagmus, though torsional, should still behave like any other type of nystagma: the key finding being a rhythmic to-and-fro movement.

    This isn’t the greatest video, but if you watch those conjunctival vessels you can see that the movement doesn’t have rhythm (try clapping your hand or tapping a table with the movement). This looks more like the fasicular movements you see with lid twitching, but in this case it’s the superior oblique muscle that is randomly firing.

  2. I have SOB and have had video taken by doctors at RPH in Perth. No I have had glasses made to suit it is quite good. I have movement when I am straining to see or driving e.g. on a country road (which I don’t often) or at night also don’t often unles I’m in the city where there are plenty of lights. Lately the superior olique muscle is jumping externally. It feels like it’s pushing out of my head. It can be seen jumping up and down quite clearly but it feels like it’s jumping out of my head. It is quite forceful and quite alarming. It is happening about 6 – 8 times a day and each time it does it, it lasts longer. I have counted it jumping up to 9 tmes straight. It is a strong movement like it’s being pinched and pulled out. I’m a bit concerned so will make an appointment to my specialist asap just in case other things are going on as lately I go to sleep on the Pc and driving and am very tired and dizzy.
    If anyone has experienced this I would like to know.
    Regards Margaret

  3. I have SOM and am flying out in a couple of weeks to see a doctor in Indianapois and I live in Texas. I have seen numerous doctors and finally I’m going to go see one that has studied and has wrote a book on SOM. Does anyone know where I can get my eye movement videoed, or what the machine or procedure is called to get this done?

  4. Ive just been diagnosed with SOM, but there doesnt seem any specialist help here in the UK, April could you tell the Drs name and title of the book hes written so i can do a little more research myself? Thanks Sam

  5. I have been suffering from SOM for about 8 years. In the early days it troubled me a lot and it was hard to get a diagnosis until I managed to video my eye myself and it was then obvious! Treatments offered have been useless and for a while I was able to live with it as the movements became more rapid and gave me more of a mirage effect. Now however it is much slower (60-100 times per minute) and is disturbing my vision considerably and I have to concentrate hard when driving. reasding has been uncomfortable for a long time but is worse at the moment. Any help would be appreciated. Thanks, Margaret

  6. I realize the comment was left a little while ago but I am interested in knowing the name of the doctor “in Indianapolis” and book to whom “April” refers above on Feb 23 2011. Any help? I have SOM and currently see Dr. Valerie Purvin here in Indianapolis. Google her. But I don’t know about a book. I have had a good bit of success treating with 80MG Propranolol SA daily.

  7. I may be suffering from SOM , i have prescribed Tegritol 100mg for 5 days, i wanna know if this condition is temporary or permenant.. please reply..

  8. I started having symptoms in 2001, after 8 years of doctors telling me i was crazy or imagining things I was finally diognosed in 2008 by a dr in reno nv. he prescribed carbatrol and i have had it somewhat under control until the last 6 months. It is like I can not keep my eye muscles under contol. In two weeks I am going to be seen in san deigo calif. I am affraid to drive as the traffic feels like it is strobbing, going into crowded stores effects me now. I hope they can get this under control.

  9. I was diagnosed with SOM a year ago and now it is in both eyes. Its my choice to take Tegretol, Timolol or Gabapentin. My tremors are on 20 second intervals. Each lasting 20 seconds at least. My Neuropthomologist wants me to take any of these meds. I looked them up and none of them seem safe to take. I’m trying to understand this very odd disorder and trying to figure out where this came from. I have worked on a computer for 32 years and seem to think it could possibly be from too much radiation maybe? If you find out any more info on this please let me know. My tremors are not caused from tilting my head. This is happens every 20 seconds and lasts up to 20seconds. It is nonstop even in my sleep. When my eyes close I feel the neurons in my forehead continue to fight their battle.
    Again, please let me know of anyone doing reserch on SOM.


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