|Year : 1988 | Volume
| Issue : 1 | Page : 35-36
Acquired double depressor palsy following acute haemorrhagic conjunctivitis
Prem Prakash, VM Menon, AK Gupta, Atul Kumar
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi-110 029, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi-110 029
Source of Support: None, Conflict of Interest: None
A case of acquired unilateral double depressor palsy following acute haemorrhagic conjunctivitis is reported.
Keywords: Acute hacmorrhixgieic Cuu-etivitis epidemic, double depressor palsy
|How to cite this article:|
Prakash P, Menon V M, Gupta A K, Kumar A. Acquired double depressor palsy following acute haemorrhagic conjunctivitis. Indian J Ophthalmol 1988;36:35-6
| Introduction|| |
Double depressor palsy is a rare disorder and is always congenital Two cases of acquired double depressor palsy have been described: , one case each of acquired double depressor palsy due to trauma and hypertension respectively. The aim of this report is to dowment yet another case of acquired double depressor palsy, following an attack of acute haemorrhagic conjunctivitis during the epidemic in Delhi in July 1981.
| Case report|| |
MP., a 34-year old male, had bilateral haemorrhagic conjunctivitis in July 1981. During the attack he noticed vertical diplopia in straight and down gaze. The conjunctivitis disappeared in 10 days but the diplopia persisted. There was no history of any other neurologic deficit.
The patient reported at our Centre in June 1984 for his visual complaints of diplopia. On examination the visual acuity was 6/6 in each eye. The anterior segment and fundus were normal The left upper lid was 2 mm higher as compared to the right upper lid There was left hypertropia of 19° with the, right eye fixating and right hypotropia of 20° with left fixating The ocular movements [Figure - 1] indicated an underaction of the superior oblique and inferior rectus muscles of the left eye which is also indicated in the Hess chart [Figure - 2]. A forced duction test ruled out any mechanical restriction Systemic examination revealed no neurologic deficit.
A haemogram, blood sugar, x-rays of the skull, paranasal sinuses, superior orbital fissures and CAT scan revealed no abnormality.
In the left eye, a 4 mm recession of the superior rectus and 8 mm recession of the inferior oblique was performed. A 5 mm resection of the inferior rectus of the left eye was done after one week with good alignment
| Discussion|| |
Double depressor palsy as such is a rare entity. The acquired type has been described only twice. ,. Lyle and Wybars attributed their case to orbital injury whereas the case reported by Nayak et al [l] was due to hypertension.
This case had vertical diplopia of acute onset thus pointing to the acquired nature of the double depressor palsy.
During the 1971 pandemic about 500,000 cases of acute haemorrhagic conjunctivitis (AHC) occurred in India.  Patients with acute neurologic syndrome of lumbosacral radiculmyelitis that appeared within 1-4 weeks of AHC were reported ,, These cases appeared shortly after the beginning of AHC epidemic and disappeared with its end However during the same pandemic, no patients with similar neurologic syndrome were seen in Japan
Collaborative studies between the groups of workers from Japan and India established by serologic tests that entrovirus-70 (EV-70) was responsible for both the conjunctivitis and the neurologic symptoms .
During the 1981 epidemic in India, Wadia et al from Bombay reported 60 cases with neurological manifestations similar to those seen in the 1971 pandemic Manju Nath et a1,  and Kono et al,  demonstrated EV-70 to be the aetiologic agent in the 1981 AHC epidemic in India
The neurologic syndrome presents in two forms The spinal form which manifests mainly as a lumbosacral radiculomyelitis and cranial form which manifests mainly as cranial nerve palsies.
The examination and investigations done in our patient did not point to any aetiologic factor for acquired double depressor palsy. The concurrence of AHC and diplopia in this case and the proven aetiologic significance of EV70 virus in causing neurologic symptoms point out that this could be responsible for the double depressor palsy.
The lesion was likely to be nuclear and this can explain a single lesion causing superior oblique and inferior rectus palsy. Midbrain lesions have been produced by acute hemmorhagic conjunctivitis (AH.C.) virus in experimental studies on monkeys' and thus a direct correlation could be established between the concurrence of haemorrhagic conjunctivitis and double depressor palsy.
| References|| |
Bharucha EP, Mandkar VP. Neurological complications of a new conjunctivitis. Lancet 2 : 970, 1972.
Kono R Uchida N Saragawa A, Akao Y, Kadama H, Mukoyama J. Fujiwara T Neurovirulence of acute haemorrhagic conjunctivitis virus in monkey. Lancet 1 : 61-63. 1973.
Kono R Miyamura K Tajiri K Shoga S, Sasagava A, Irani PF, Katrak SK Wadia NH. Neurological complications associated with acute haemorrhagic conjunctivitis virus infection and, its neurological confirmation. J. Inf. Dis., 129 (5) :590-593, 1974.
Kono R Miyamura K Ogino T, Wadia NK Katrak SK Mishra VP. Antibody titres to enterovirus type 70 in Indian Epidemic of AHG Lancet 2 424, 1981.
Lyle Keith and Wybar KG Practical orthoptics in the treatment of squint (and other anomalies of binocular vision) 5th Edition, 519-521, ILK Lewis & Co. Ltd, London, 1967.
Manju Nath N, Balaya, Mahajan VM Isolation of Enterovirus-70 during the conjunctivitis epidemic in Delhi in 1981, Ind. J. Med Res., 76, P-653-655, 1982.
Nayak BY ,
V. Menon, P. Prakash Acquired double depressor palsy. Ind. J. Ophthalmol., 131 :77-79, 1983.
Wadia NH, Iran PF, Katrak SM Neurological complications of a new conjunctivitis. Lancet 2 : 970-971, 1972.
Wadia NM, Iran PF, Katrak SM Lumbosacral radiculomyelitis associated with pandemic acute haemorrhagic conjunctivitis Lancet 1 : 350-352, 1973.
[Figure - 1], [Figure - 2]