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Year : 1983  |  Volume : 31  |  Issue : 2  |  Page : 77-78

Acquired double depressor palsy

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S.. New Delhi, India

Correspondence Address:
B K Nayak
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi-24
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PMID: 6662574

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How to cite this article:
Nayak B K, Menon V, Prakash P. Acquired double depressor palsy. Indian J Ophthalmol 1983;31:77-8

How to cite this URL:
Nayak B K, Menon V, Prakash P. Acquired double depressor palsy. Indian J Ophthalmol [serial online] 1983 [cited 2021 Jun 24];31:77-8. Available from: https://www.ijo.in/text.asp?1983/31/2/77/27443

Simultaneous paralysis of Inferior rectus and superior oblique of the same eye, the so called double depressor palsy is a rare entity.[1] von-Noorden[2] mentions that no case of acquired double depressor palsy has been re­ported. However Kieth Ly le[3] 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 Top

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.


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[4] or it could be at supranuclear level near superior colliculus as envisaged for double elevator palsy by Jampel and fells.[5],[6]

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 Top

A rare case of acquired right double de­pressor palsy caused by hypertension is being reported.

  References Top

Duke-Elder S. 1973. System of Ophthalmology Vol. Vt Henry Kimpton London, p. 729,  Back to cited text no. 1
Burian, M.A. and von Noorden. 1980, Physio­logy of the Sensorimotor cooperation of the eyes C:V. Mosby C. P. 373.  Back to cited text no. 2
Lyle and Jackson, 1967, practical orthoptics in the treatment of squint, H.K. Lewis & Co.. Ltd, p. 519.  Back to cited text no. 3
Wolffe. 1976. Anatomy of the eye and orbit, H.K. Lewis and Co. Ltd. p. 285.  Back to cited text no. 4
Jampel. R.S., and Fells, p. 1968, Arch. Ophthal. 80 : 45.  Back to cited text no. 5
Fells and Jampel. 1970. Trans Ophthalmol Soc U.K. 90 : 471  Back to cited text no. 6


  [Figure - 1], [Figure - 2], [Figure - 3]


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