ABSTRACT

We describe a patient with left double elevator palsy who had been referred to our strabis-mus department with a diagnosis of right hypertropia and amblyopia. The patient was a 22-ye-ar-old man. He had a hypertropia of 40 PD in the primary position in his hyperopic right eye (+3.50 D). The best corrected visual acuity was 0.3 in this amblyopic right eye. The patient had 2 mm of ptosis and eyebrow elevation in his left eye in the primary position with no elevation of the eye above the horizontal plane. He showed a left hypotropia of 30PD while fixating with right eye. He had a recession of left inferior and right superior recti after the forced-duction test. Postoperatively he still had a 2mm ptosis despite the orthophoria in primary position. Two we-eks after the first operation a levator aponeurosis tucking through the skin was made. After the second operation an orthophoria and lid symmetry in the primary position were achieved. As a conclusion, the exa.minat.ion of a patient with double elevator palsy in the dominant eye may misdirect the ophthalmologist. An elevation deficiency of the other eye should always be exa-mined in a patient with hypertropia. The recession of vertical recti should be considered first, before aggressive transposition procedures in the case of amblyopia in the other eye.