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A Few Facts About 4th Nerve Palsy. A little known or understood disorder, 4th Nerve Palsy is an eye disorder in which the usual symptom is that of double vision.In this particular case, double vision means the image seen through one eye appears to be slightly above the image seen by the other eye. The exact cause of this disorder is not always known.hen this nerve suffers from a disorder, such as palsy, the movement of the eye is affected. The eye's gaze will tend to drift upward and perhaps slightly inward. The upward drift of the eye's gaze is called hypertropia.
To compensate for the double-vision resulting from the weakness of the superior oblique, patients characteristically tilt their head down and to the side opposite the affected muscle. When present at birth, it is known as congenital fourth nerve palsy.his condition often causes vertical or near vertical double vision as the weakened muscle prevents the eyes from moving in the same direction together. Because the fourth cranial nerve is the thinnest and has the longest intracranial course of the cranial nerves, it is particularly vulnerable to traumatic injury.