Neurofibromatosis-1 with Superior Oblique Palsy Case Report

Superior oblique palsy (SOP) is an uncommon ocular manifestation in patients with neurofibromatosis type 1 (NF1). This case is unique as it highlights the coexistence of NF1 with multiple systemic and neurodevelopmental complications, and it adds to the limited literature describing strabismus management in such patients. An 18-year-old female with a history of NF1, scoliosis, and attention-deficit hyperactivity disorder (ADHD) presented with vertical diplopia due to SOP. She initially underwent right superior rectus recession in 2022, followed by left inferior rectus recession in 2023 for residual vertical strabismus. Postoperatively, ophthalmological examination revealed mild residual strabismus with a satisfactory cosmetic outcome. Sequential surgical correction improved ocular alignment and cosmesis, with stabilization of symptoms on follow-up. This case underscores the importance of a multidisciplinary approach in managing NF1, especially when rare ophthalmological complications such as SOP are present. Early recognition, individualized surgical planning, and coordinated follow-up can optimize both functional and cosmetic outcomes.