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LETTER TO EDITOR |
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Year : 2010 | Volume
: 58
| Issue : 6 | Page : 556-557 |
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Author's reply: Vertical synergistic divergence: A distinct separate entity
Jitendra Jethani
Pediatric Ophthalmology and Strabismus Clinic, Dr. Thakorbhai V Patel Eye Institute, Haribhakti Complex, Salatwada, Vadodara - 390 001, Gujarat, India
Date of Web Publication | 16-Oct-2010 |
Correspondence Address: Jitendra Jethani Pediatric Ophthalmology and Strabismus Clinic, Dr. Thakorbhai V Patel Eye Institute, Haribhakti Complex, Salatwada, Vadodara - 390 001, Gujarat India
Source of Support: None, Conflict of Interest: None | Check |
How to cite this article: Jethani J. Author's reply: Vertical synergistic divergence: A distinct separate entity. Indian J Ophthalmol 2010;58:556-7 |
Dear Editor,
I read the comments given by Pandey et al. [1] It is difficult to understand how they could convert this case [2] into a bilateral Brown's syndrome (BS) case. The only finding that bilateral superior oblique overaction is present does not point to a bilateral BS. The child on elevation of the left eye showed a direct depression of the right eye [Figure 1]. There is a limitation of the right eye in depression. Why should that happen in a bilateral BS? The lid retraction was present in downgaze [2] and not in adduction, very similar to one seen in pseudo-Von Graefe's sign. The adduction, depression in abduction, and elevation in adduction were restricted in the right eye but not in the left. [2] A right eye BS would not have the limitation of depression in abduction as was seen in our case. [2] The ductions were completely normal in the left eye and so a question of BS in the left eye does not arise. No Marcus Gunn jaw wink was seen which was supposedly completing the jigsaw puzzle for the authors. A forced duction test was not overlooked but the child was not cooperative and his parents did not consent for general anesthesia. [2] Not everything can be written about the case (which was discussed with the reviewers) because of the word limit. | Figure 1: The picture clearly demonstrates the restricted depression and eyeball moving downward in the vertical gaze
Click here to view |
The authors have wasted time and space by writing more and more about bilateral BS which was not necessary. [1] I have put up my explanation which happens to be contrary to the opinion of Pandey et al. [1] In science, one should respect other's opinion and I would just respect their opinion.
References | | |
1. | Pandey PK, Dadeya S, Singh A, Vats P, Rathi N. Misinnervation in 3 rd nerve palsy: Vertical synergistic divergence or consummate congenital bilateral asymmetrical Brown's syndrome with congenital ptosis? Indian J Ophthalmol 2010;58:55-6 |
2. | Jethani J. Misinnervation in third nerve palsy: Vertical synergistic divergence. Indian J Ophthalmol 2009;57:476-7. [ PUBMED] |
[Figure 1]
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