The fourth nerve

Doc, I think my eyes are playing tricks on me,” said Vikram, a lanky 17-year-old who looked like he’d rather be skateboarding than sitting in my clinic.

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He sported a colourful cast on his left arm, a souvenir from a recent attempt to defy gravity, and his eyes darted around nervously, as if expecting the furniture to jump out and attack him. “Playing tricks how?” I asked. “Well,” he began, his voice cracking slightly, “everything seems tilted. Like, the world’s decided to lean over for a nap.”

Now, tilted worlds are usually not part of a teenager's everyday experience, unless they've been experimenting with substances best left to horticultural enthusiasts. Vikram, however, assured me that his only indulgence was an overabundance of video games. A quick examination revealed the culprit: his left eye was doing a subtle ‘up and in’ impression, as if trying to get a better view of his brain. Clearly, the fourth cranial nerve, the delicate little trochlear nerve responsible for guiding the eye's downward and inward gaze, had decided to take a vacation.

“So, what's the damage, doc?” Vikram asked, his voice a mix of bravado and genuine concern. “Is this going to be like a permanent tilt-a-whirl situation?”