|Year : 1985 | Volume
| Issue : 2 | Page : 133-134
An unusual case of bilateral superior rectus palsy
BD Sharma, SK Sachan
State Institute of Ophthalmology, Allahabad, India
B D Sharma
State Institute of Ophthalmology, Allahabad (U.P)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma B D, Sachan S K. An unusual case of bilateral superior rectus palsy. Indian J Ophthalmol 1985;33:133-4
Bilateral congenital superior rectus palsy is not an uncommon condition,,. But bilateral superior rectus palsy associated with the unusual lid movements as observed in the present case is a rare entity and hence this case is being reported.
| Case report|| |
N.A., 10 years old boy reported to the squint clinic with the complaints of intermittent upshoot of right eye since birth and difficulty in reading and near work for last five years. There was no history of trauma at birth, meningitis, encephalitis or any other acute illness. No family history of this type was present. No history of diplopia was found.
On Examination-Slight head tilt was present towards Rt. side. There was no deviation of eyes in primary position and on fixing near objects. There was no change in the position of eyeball on forcible tilting of head towards Lt. shoulder. Upshoot of right eye was present on looking at distance.
Ocular Movements:- Monocular-normal: Binocular-Limitation of movements of both superior recti in dextro and laevo-elevation positions. [Figure - 1] Up shoot of right and left eyes in leavo and dextro-elevation position respectively.
Unusual lid Movements:-There was simultaneous narrowing and widening of palpebral fissures of abducting and adducting eyes respectively during dextro and laevoversion positions [Figure - 2].
Cover Test:- Showed Right latent hyper tropia. There was no diplopia
Anterior segment and Fundi :-Normal
Vision : R.E. 6/60 with-1.25 D. Sph/1.5 D. Cyl. 180 Axis 6/60 and L. E. 6/12 with -1.00 D. Cyl. 180 Axis 6/9.
| Discussion|| |
Our diagnosis was based on the limitation of movements of both superior recti, overaction of opposite inferior obliques and no change in the position of the eye balls by Bielschowsky's head tilting test.
The unusual narrowing and slight widening of palpebral fissures of abducting and adducting eyes respectively was an abnormal finding in the case. Similar type of narrowing and widening has been mentioned in cases of aberrant regeneration of third nerve. He has explained it on Sherrington's concept of reciprocal innervation of extra-ocular muscles. According to this when the lateral rectus muscle contracts, there is diminution in tone of internal rectus. Consequently in the instance of regeneration of fibres of the third nerve with misdirection the levator palpebrae has a tonic innervation when impulses are directed through the third nerve, but when impulses are directed toward the sixth nerve the tonus of the levator is decreased markedly leading to narrowing of the palpebral fissure.
In the present case also narrowing and widening of palpebral fissures may be explained on the same basis of aberrant regeneration of third Nerve.
| Summary|| |
A case of congenital bilateral superior rectus palsy is presented with an unusual finding of narrowing and slight widening of palpebral fissures of abducting and adducting eyes respectively.
| References|| |
Duane, 1905, Arch, Ophthalmol. 34: 133
Anderson, 1947, Brit. J. Ophthalmol. Sppl. 12 : 61
Epstein, 1947, Arch. Ophthalmol., 37: 369.
Hofman and Bielschowsky, 1900, D. Graefes Arch Ophthalmol. 51 : 174.
Walsh. F.B , 1957, Clinical Neuro Ophthalmology p. 195.
[Figure - 1], [Figure - 2], [Figure - 3]