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Year : 1978  |  Volume : 26  |  Issue : 1  |  Page : 39-42

An unusual case of synkinetic ptosis


State Institute of Ophthalmology, M.L.N. Medical College, Allahabad, India

Correspondence Address:
D B Chandra
State Institute of Ophthalmology, M.L.N. Medical College, Allahabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 711276

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How to cite this article:
Chandra D B, Sharma B D, Srivastava R K. An unusual case of synkinetic ptosis. Indian J Ophthalmol 1978;26:39-42

How to cite this URL:
Chandra D B, Sharma B D, Srivastava R K. An unusual case of synkinetic ptosis. Indian J Ophthalmol [serial online] 1978 [cited 2024 Mar 19];26:39-42. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1978/26/1/39/31456

Paradoxical movements of upper lids consti­tute a rare type of congenital anomaly, being noted either as an association with movements of other extraocular muscles-the medial, lateral or inferior rectus or with the muscles of mastication (external pterygoids). They are all outside the volition of the patient and cannot be controlled. They may be termed associated reflexes of misdirection and are presumably due to the major portion of the innervation of the extrinsic muscle involved terminating in the levator'. Not many cases of this type are on record, hence this case is being reported.


  Case Report Top


A 15 years male was seen first in the out patient department of the State Institute of Oph­thalmology, at M.D. Eye Hospital, Allahabad. His only complaint was of slight drooping of right upper lid since birth which was non-pro­gressive. There was no history of meningitis, encephalitis, small pox, measles, diphtheria, trauma or epileptic fits. No family history was found.


  On Examination Top


On looking straight, there was first degree of ptosis in the right eye there was overaction of the occipito-frontalis and on pressing the brow firmly down there was complete absence of lid elevation. The ocular movements were normal in all the cardinal direction of gaze. Movements of jaw had no influence upon the position of lids. The interesting finding was ptosis in left eye on dext­roversion (Photo No. IV) which was normal in looking-straight position. Similarly the ptosis in right eye also increased on laevoelevation (Photo No. VII). There was no effect on the lids on adduction or convergence.

Lateral recti were normal and there was no retraction of the globe on adduction. Pupillary and accommodation reflexes were normal. Ocular adenexa and Ophthalmoscopic examina­tion were normal. Visual acuity was 6/9 left eye and visual fields were within normal limits.


  Analysis Of Movements Top


a) Looking Straight:

The position of eye balls was normal and there was slight Ptosis in right eye [Figure - 1]

b) Looking up:

There was complete absence of lid elevation in R.E. and the overaction of Occipitofrontalis muscle was present. The upward movement of eye balls was normal. [Figure - 2]

c) Looking down:

Movements normal [Figure - 3]

d) Dextroversion:

The movements were normal with an interest­ing finding of ptosis in left eye [Figure - 4]

e) Laevoversion:

Movements normal [Figure - 5]

f) Dextroelevation:

Movements normal. [Figure - 6]

g) Laemelevation:

The movements were normal but the ptosi,in right eye increased.

h) Dextrodepression:

Movements normal. [Figure - 8]

i) Laevodepression:

Movements normal. [Figure - 9]

j) Movements of jaw:

There was no effect on ptosis in such move­ments. [Figure - 10]

Size Of Palpebral Fissure In Different Positions Of Gaze

                                  R .E. L.E.

(a) Looking straight 8m.m. 10mm.

(b) Looking up 7mm. 14mm.

(c) Looking down 7mm. 5mm.

(d) Dextroversion 8mm. 5mm.

(e) Laevoversion 7mm. 12mm.

(f) Laevoelevation 5mm. 13mm.


  Discussion Top


Raising or lowering of the upper lid with lateral movements of the eyes usually accom­panies contraction of the medial rectus either in adduction or convergence. The most commonly reported movement is a spasmodic elevation of the lid on the side of the contracting muscle,[1],[2],[3],[4]

But a lowering of the lid as present in the case under report has been observed only by Fuchs[2]. Moreover, that the phenomenon may occur bilaterally as well (both eyes being involved in either movements) has been rather rare, as typified in this case. Only Phillips[3] reported a similar case. The case reported by Phillips consisted of two brothers. But no case having synkinetic ptosis both on dextroversion and laevoelevation has been reported so far. In this respect, the case under report is an excep­tion.

Since satisfactory explanation has not yet been advanced to elucidate the rationale of all such associated movements, the most commonly accepted hypothesis that an abnormal nervous connection exists in the central nervous system between the nerve supply of the levator and the associated muscle will have to be postulated for this case as well.


  Summary Top


A case of synkinetic lid movements is presented with hitherto unreported finding of ptosis both on dextroversion and laevoelevation, besides other interesting features.

 
  References Top

1.
Browning, 1890, Trans-Ophthal. Soc., U.K., 10, 187.  Back to cited text no. 1
    
2.
Fuchs, E., 1895, Beitr-Augenheilk, 2(ii), 12.  Back to cited text no. 2
    
3.
Phillips, 1887, Trans-Ophtha!. Soc., U.K., 7,306.   Back to cited text no. 3
    
4.
Spaeth, 1947; Amer. J. Ophthal., 30, 143.  Back to cited text no. 4
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11]



 

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  In this article
Case Report
On Examination
Analysis Of Move...
Discussion
Summary
References
Article Figures

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