Double elevator palsy treated at the age of 11 months: A case report

Sugaho Akira

Purpose: To describe the postoperated course in an infant with double elevator palsy who underwent treatment at the age of 11 months.

Case report: The patient was a 3-month-old female infant. At the initial visit, her eye position showed a primary deviation of 15°LHT (left hypertropia). Down gaze, right gaze, and left gaze deviations were also 15°LHT . Up gaze deviation was 20°LHT . Fixes were well with both eyes. Bielschowsky head-tilt test was negative. With respect to eye movement, there was a elevate limitation of the right eye in ductions and versions. The left eye in up gase showed up shoot in versions. MRI findings of the orbits and brain were normal. We tried the forced duction test to confirm whether inferior rectus muscle was tight. On the basis of these findings, we diagnosed the infant with double elevator palsy. And we treated her for vertical transposition of the horizontal rectus muscles (Knapp procedure) at the age of 11 months.

Result & Conclusion: Up shoot in the left had improved. The primary deviation in eye position was almost unchanged (15° LHT). Upward imitation of right eye was almost unchanged. Burke JP (1992) and Calderia JA (2000) reported that the Knapp procedure had an increasing effect of surgery over time. We will evaluate the patient's eye position during follow-up visits, and thereby discuss about addition of inferior rectus muscle recession.