Monocular elevation deficit management

Abstract

Aim The aim of the study is to study cases of monocular elevation deficit (MED), and find an appropriate procedure to follow in management. Patients and methods This prospective study included 21 patients presenting with MED, complete ocular examination including ocular motility examination in all directions, forced duction test (FDT) were performed, then cases having hypotropia in the affected eye in primary position were operated, and the choice of operation was depending on the result of FDT. Results The total number of cases was 21 patients, 18 patients had hypotropia in primary position accompanied by pseudoptosis, and three cases had no hypotropia. Sixteen cases of hypotropia had positive FDT, inferior rectus muscle recession by hang back procedure was performed in them, while in two cases of hypotropia with negative test, Knapp’s muscle transposition was performed. All operated cases had postoperative good ocular alignment and spontaneous regaining of normal lid position except two cases. Cases with no hypotropia were not operated and only followed up. Conclusion MED or double elevator palsy, can present with hypotropia and pseudoptosis, so requiring management, or presenting with normal eyes in primary position, requiring follow up. The choice of surgical procedure depended on results of FDT.