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ARTICLES |
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Year : 1978 | Volume
: 26
| Issue : 1 | Page : 39-42 |
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An unusual case of synkinetic ptosis
DB Chandra, BD Sharma, RK Srivastava
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
Source of Support: None, Conflict of Interest: None | Check |
PMID: 711276
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 |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
A case of synkinetic lid movements is presented with hitherto unreported finding of ptosis both on dextroversion and laevoelevation, besides other interesting features.
References | | |
1. | Browning, 1890, Trans-Ophthal. Soc., U.K., 10, 187. |
2. | Fuchs, E., 1895, Beitr-Augenheilk, 2(ii), 12. |
3. | Phillips, 1887, Trans-Ophtha!. Soc., U.K., 7,306. |
4. | Spaeth, 1947; Amer. J. Ophthal., 30, 143. |
[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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