|Year : 1983 | Volume
| Issue : 2 | Page : 77-78
Acquired double depressor palsy
BK Nayak, V Menon, Prem Prakash
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S.. New Delhi, India
B K Nayak
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi-24
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nayak B K, Menon V, Prakash P. Acquired double depressor palsy. Indian J Ophthalmol 1983;31:77-8
Simultaneous paralysis of Inferior rectus and superior oblique of the same eye, the so called double depressor palsy is a rare entity. von-Noorden mentions that no case of acquired double depressor palsy has been reported. However Kieth Ly le describes one case of acquired double depressor palsy of traumatic origin. Recently we came across a case of acquired double depressor palsy of right eye which is worth reporting due to rarity in incidence.
| Case report|| |
A 46 years old male, came with complaints of diplopia in front and down gaze of 10 days duration. No significant history could be made out except that the patient was hypertensive. General physical examination revealed no abnormality but hypertension was not under control at that time. His blood pressure was recorded consistently as 160/100 mm of Hg. Haemogram. X-ray orbit and skull. blood sugar and neurological check up revealed no abnormality.
On local examination. vision in both eyes was found to be normal. Right eye was hypertropic with restriction of movement on dextro-and levo-depression. The anterior segment showed no abnormality. Fundus examination revealed normal fundus. Fixation of both eyes was central. Prism bar cover test revealed right hypertropia of 4 o. 12° and 26 o in upgaze, straight gaze and down gaze respectively for distance, while fixing with left eye, and right hypertropia of 5 o, 22° and 32° while fixing with right eye in the above mentioned three positions of gaze.
Diplopia charting [Figure - 1] revealed heteronymous diplopia with vertical separation of images seen maximally in down gaze. specially in dextrodepression. Hess charting [Figure - 2] was consistent with palsy of superior oblique and inferior rectus of the right eye.
Patient was advised proper control of blood pressure and occlusion of one eye to obviate diplopia. On follow up after Four months with control of blood pressure, right hypertropia was reduced to ortho, 2 o and 3° in up, straight and downgaze respectively. Ocular movements were normal and Hess screen charting [Figure - 3] revealed near normal muscle action and subjectively the patient was totally diplopia free.
| DiSCUSSION|| |
The rarity of incidence of double depressor palsy can be explained by the fact that the inferior rectus and superior oblique are supplied by two different cranial nerves i.e. III and IV nerves respectively. Hence it is difficult for a single lesion to involve these two muscles simultaneously and only congenital cases are described.
The possible sites of lesion could be either at the level of nuclei of inferior rectos and superior oblique which is closely situated according to nuclear arrangements described by Bernheimer and Brouwer or it could be at supranuclear level near superior colliculus as envisaged for double elevator palsy by Jampel and fells.,
In the present case it could be a vascular pathology due to the presence of high blood pressure resulting in the involvement of the said nuclei or centre, which got resolved in due course of time with the control of hypertension, thus resulting in recovery in due course of time. It indicates that no permanent damage had taken place in the affected nuclear centre.
| Summary|| |
A rare case of acquired right double depressor palsy caused by hypertension is being reported.
| References|| |
Duke-Elder S. 1973. System of Ophthalmology Vol. Vt Henry Kimpton London, p. 729,
Burian, M.A. and von Noorden. 1980, Physiology of the Sensorimotor cooperation of the eyes C:V. Mosby C. P. 373.
Lyle and Jackson, 1967, practical orthoptics in the treatment of squint, H.K. Lewis & Co.. Ltd, p. 519.
Wolffe. 1976. Anatomy of the eye and orbit, H.K. Lewis and Co. Ltd. p. 285.
Jampel. R.S., and Fells, p. 1968, Arch. Ophthal. 80 : 45.
Fells and Jampel. 1970. Trans Ophthalmol Soc U.K. 90 : 471
[Figure - 1], [Figure - 2], [Figure - 3]