Kevin L. Shen; Kimberly G. Yen, MD


March 18, 2016

Case Diagnosis

The inability to elevate one eye in both the adducted and abducted positions is consistent with the diagnosis of double elevator palsy (DEP), also known as "monocular elevation deficiency."

Brown syndrome is caused by restriction of the inferior oblique muscle, which results in impairment of elevation during adduction but not abduction.

Although congenital third nerve palsy can cause ptosis and impaired elevation, it also commonly causes exotropia and impaired adduction owing to loss of function of the medial rectus muscle.

Patients with congenital ocular fibrosis syndrome are more likely to experience bilateral symptoms of restriction in more than one direction of gaze. They often have other congenital defects, including intellectual and social disability.

Thyroid-associated orbitopathy, also known as "Graves ophthalmopathy," would probably cause more ocular signs and symptoms, including chemosis, proptosis, and lid edema. Patients would also be expected to have systemic signs of thyroid disease.

Clinical Course

Because the child was never treated for amblyopia, he was given glasses (plano in the right eye and +4.00 in the left eye) to correct his anisometropia, and a trial of patching of the right eye was offered to the family. The DEP was monitored because the patient did not have a significant misalignment in primary gaze or significant head position.


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