The cause of primary eye movement abnormality is unknown. The functional MRI of superior and inferior oblique muscles was instrumental to investigate the cause of overaction. We have shown similar size of superior oblique muscle in patients and controls in the resting state, while the MRI performed during gazes revealed differences in the contractility, what suggests the abnormal innervation as a cause of primary superior oblique muscles. In contrast, the inferior oblique muscle was larger in resting state, without a difference in contractility what indicates the hypertrophy as a basis for primary inferior oblique muscle overaction.
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