Dr. Shalu Pal

  • "If you want quality and wonderful service, please go to Dr. Shalu Pal! The patience, care, and true concern that Dr. Pal has for her clients is wonderful. "

    --Seleena J
  • " I was pleasantly surprised by finding a hidden gem within Dr. Pal's office"

  • "Finally a doctor who is extremely knowledgeable, patient and explains things clearly. She is a wonderful human being who really takes the time to care for your needs. The office has a wonderful atmosphere and the staff are just as helpful as Dr. Pal. "

  • "I couldn't ask for a better Optometrist. She is a delight to deal with, very patient, helpful and extremely knowledgeable. She was very good with my kids who can be very fussy at times.. And who could ask for a more beautiful location. Highly Recommend! "

    --Natalie M.
  • "My wife and I, highly recommend Dr. Pal. The staff, the service, the merchandise, are all top notch. They really make you feel welcomed. It has been several years since I have been able to see this well !!! You and your staff are the best !!!! "

    --Steve and Maria L.
  • "We barely go to optometrists so when we do, we should look for the best! I am super pleased I chose Dr. Pal\'s office. They were helpful from beginning to end, from booking on the phone to my actual visit. Dr. Pal was very detailed and went in-depth about my eye health. She is very patient and made me feel calm. The optician helped me pick a great pair of glasses, they were genuinely friendly which is a huge bonus."

    --Ahmad S
  • "I have been going to Dr. Pal for several years now. My most recent visit on June 6, 2016 was the best experience there that I have ever had. Firstly, the women on the desk were friendly and efficient - a very good prelude to my examination. Dr. Pal, herself, was, as usual, very thorough and encouraging in her examination. And she puts you at ease before we get into the eyes examination by discussing other things in life. That helps to ease any stress I may have. And they now have a man in the office who does that difficult examination (name of which I do not know!). He is so patient and encouraging and made the exam not so difficult for me this time. After all that, I saw Dr. Pal again before I left and she told me my eyes were good! Even had the news been not so good, I believe that I would be able to handle it because I truly believe that Dr. Pal and her staff would have taken good care of me. I will always go back to Dr. Pal and members of her team because I truly believe"

    --A. Howlett
  • " I have been to a few appointments at Dr. Pal\'s office over the last year for dry eye issues and every time it has been a very positive experience. The 3 receptionists at the front desk are warm and friendly. They are attentive and provide a very high level of customer service. I appreciate that they call me by name and remembered conversations we had at previous visits. I find Dr. Pal to be an excellent practitioner who is very thorough with her exams, has a lovely personality and takes the time to answer any and all questions that may arise. I am happy with the computer glasses I purchased and value the honest opinions I received from the staff when selecting frames. It was refreshing to have multiple opinions on styles and I felt they truly wanted me to walk out with a frame that was best suited to me. I highly recommend Dr. Pal \'s office! As a health care practitioner myself, I think all health care experiences should be this personilzed and friendly!"

    --A. Mclean
Fourth Nerve Palsy


Fourth Nerve Palsy


There are ten cranial nerves, each in charge of a different function, like the sense of smell, the optic nerve, and the one that controls most eye movement. The fourth nerve, the trochlear, is in charge of only one eye muscle, called the superior oblique, which moves each eye downward and inward, with some rotational effect also.

The fourth nerve, also called the trochlear nerve is the longest of the cranial nerves, and the one most sensitive to damage from trauma (head injury) or damage from circulation malfunction, as may be seen in high blood pressure or diabetes. The fourth nerve is also susceptible to malfunction due to genetics and nerve malfunction due to multiple sclerosis. The best treatment for fourth nerve palsy depends on the cause, as some acquired palsies may resolve by themselves over time, while others may require treatment.

The term paresis indicates a partial dysfunction, while palsy is a complete lack of function.

Fourth nerve palsy, also known as trochlear nerve palsy, can be tricky to diagnose because the eyes may at first appear to align normally, but in most cases, there will be some amount of diplopia, or double vision, which may cause people to tilt the head in the direction away from the affected eye. That is, if the palsy or paresis of the superior oblique muscle affects the right eye, the tilt of the head will be to the left, which makes it easier to avoid or reduce constant double vision.

Signs and Symptoms

Although some people with fourth nerve palsy may be asymptomatic, any of the following symptoms and signs may be present:

  • Double vision when both eyes are open, and which disappears when one eye is closed or covered.
  • Double vision with the two images stacked one above the other, not side-by-side
  • Double vision that worsens when looking downwards
  • A noticeable head tilt, which helps alleviate the double images
  • In straight gaze, the affected eye may appear to look upward
  • A sensation that objects appear tilted or rotated rather than straight up and down
  • More difficulty when reading or other close-up activities
  • Usually fourth nerve or trochlear palsy affects only one eye, but some cases are bilateral.

Three-step testing can help pinpoint the source of diplopia and eliminate possible causes until the muscle dysfunction can be narrowed down to only one.


In congenital fourth nerve palsy, eye muscle surgery may be indicated sometime after the patient’s first birthday, to help align the eyes and prevent later vision problems, including head tilting to make it easier to avoid double vision.

If the cause of the palsy is head trauma, surgery should be postponed for at least six months to a year, because sometimes the amount of misalignment may decrease or even disappear. Rather, it may be better to use a type of stick-on prism known as a Fresnel lens, which can be changed as the amount of head tilt and/or diplopia decreases.

The prognosis for recovery of normal function is better in the case of circulatory causes than in head trauma, although even those cases caused by head injury seem to resolve at a rate of about 50%.

While waiting to see if the condition improves on its own, a patch over the affected eye will eliminate the double vision and prevent development of a head tilt to compensate. Either changeable Fresnel stick-on prisms or ground-in lens prisms can be useful to compensate.

If the diplopia is not showing a reduction over time, eye muscle surgery may be indicated, although other interventions should be attempted first.

2024 © EyeconX. All rights reserved          Home    |    About Us    |    Media    |    Lens Reorder    |    Our Practice    |    Education    |    Contact Us