Inferior Rectus Paresis Research Articles

Clinical findings and surgical outcomes of patients with traumatic isolated inferior rectus muscle paresis

To evaluate clinical findings and surgical outcomes of patients with traumatic isolated inferior rectus muscle paresis. The medical records of patients with traumatic isolated inferior rectus paresis who underwent strabismus surgery at Farabi Eye Hospital between 2011 and 2018 were reviewed retrospectively. Clinical features, type of surgery, and surgical outcomes were extracted from the record for analysis. A total of 19 patients (14 males [74%]) were included. Mean patient age was 34.8±14.6years. Left eyes in 13 patients (68%) were involved. Thirteen cases (68%) underwent orbital reconstruction surgery for blow-out fracture. Preoperative limitation of duction in the gaze of the inferior rectus muscle was -2 to -3 in all cases. Four patients (21%) had a paradoxical contralateral compensatory head tilt. Inferior rectus muscle resection alone was the first surgical intervention in 12 patients (63%). At the final follow-up, 12 patients (63%) were orthotropic, without any deviation or diplopia in primary position and downgaze. Three patients (16%) had a residual hypertropia of 3Δ at distance and near without diplopia, and 4 patients (21%) required reoperation. In our patients with traumatic isolated inferior rectus paresis with persistent deviation at least 6months after trauma, a stepwise approach based on size of the vertical deviation was employed, with good outcomes: inferior rectus resection alone for hypertropia of 6Δ-20Δ and inferior rectus resection and superior rectus recession for hypertropia of ≥20Δ or significant hypertropia in the field of the superior rectus muscle.

A Case of Generalized Myasthenia Gravis Presenting as an Isolated Inferior Rectus Paresis

A Case of Generalized Myasthenia Gravis Presenting as an Isolated Inferior Rectus Paresis

New strabismus surgical techniques

Five new strabismus surgical procedures were developed by the authors and were presented as a workshop at the AAPOS annual meeting of the American Association for Pediatric Ophthalmology and Strabismus. They are summarized here to introduce these methods to the reader and provide surgeons with more options in approaching difficult strabismus problems. Diagnosis and correction of consecutive strabismus attributable to stretched scar is discussed. The pulley posterior fixation procedure is a unique approach to correct high accommodative convergence or to augment a maximal medial rectus recession. Diagnosis and repair of the partial avulsion (flap tear) of a rectus muscle allows correction of some restrictive strabismus following blunt trauma. The nasal myectomy of the inferior oblique muscle corrects persistent inferior oblique overaction without sacrificing the tether effect gained by a previous anterior transposition of the inferior oblique. The full advancement of the superior oblique tendon offers another option to strengthen a weak superior oblique muscle.

Inferior rectus paresis and medial rectus overaction following retrobulbar anesthesia for cataract surgery

Strabismus is a well recognized complication of retrobulbar anesthesia for cataract surgery. This may manifest as either paresis or sometimes contracture (overaction) in the late stage. Management of the patient is tailored to the individual case. Herein, we report a patient with inferior rectus paresis and medial rectus overaction after retrobulbar anesthesia. The presenting symptom was diplopia increasing on downgaze, which improved with medial rectus recession and plication of the inferior rectus.

Isolated Inferior Rectus Paresis in a Patient with a History of Lymphoma

Isolated Inferior Rectus Paresis in a Patient with a History of Lymphoma

Isolated Inferior Rectus Palsy: A Case Report and Review of Literature

A case of sudden-onset isolated inferior rectus paresis is described. This is a rare presentation of isolated oculomotor nerve paresis and its features are described. Lesions of the oculomotor nerve can affect any of the functions of the extraocular muscles depending on the location and the aetiology of the lesion. An interesting subgroup of patients having isolated paresis of inferior rectus muscle without involvement of the other muscles has always drawn special interest. The purpose of this article is to report a case of binocular vertical diplopia resulting from an isolated, unilateral inferior rectus paresis followed by a review of the existing literature along with a discussion of neuroanatomy, aetiology, clinical features and management. Clinicians may increase their awareness of the spectrum of various possible causes that can present with isolated IRM palsy.

Surgery for Strabismus Secondary to Ethmoid Sinus Surgery

To review the outcome of surgery for strabismus due to ethmoid sinus surgery. The series comprised 13 cases, 1 of inferior rectus paresis, 1 of superior oblique paresis, 6 of medial rectus paresis, and 5 of medial rectus muscle palsy due to third nerve palsy. In the cases of paresis of the rectus muscle, resection of the rectus muscles was mainly performed. In the cases of palsy of the rectus muscle, transposition of the extraocular muscle with simultaneous recession of the lateral rectus muscle was performed. The major aim of surgery was to bring both eyes into alignment and to eliminate diplopia in the primary position. The mean preoperative horizontal deviation of 18.1 degrees of exotropia in the paresis cases was reduced to 1.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 3.8 degrees of hypertropia was reduced to 1.4 degrees of hypertropia postoperatively. The mean preoperative horizontal deviation of 35.6 degrees of exotropia in the palsy cases was reduced to 9.4 degrees of exotropia after surgery. The mean preoperative vertical deviation of 2.0 degrees of hypertropia was increased to 2.6 degrees of hypertropia postoperatively. Postoperatively, diplopia was absent in 11 cases with a slightly compensatory head posture. Surgery for strabismus due to sinus surgery induces improvements in eye position and diplopia.

Acquired Strabismus following Cosmetic Blepharoplasty

The purpose of this study was to report on 12 patients with acquired strabismus following cosmetic blepharoplasty and to identify patterns of strabismus related to the surgical procedure. Clinical ophthalmologic examinations were performed to specifically clarify the type of strabismus. Operative reports of the blepharoplasty procedures were reviewed. Patients were followed for a minimum of 3 months after the blepharoplasty procedure before surgical intervention was considered. Operative findings at corrective strabismus surgery were noted and an attempt was made to correlate these findings with the clinical ophthalmologic examination and the blepharoplasty surgical procedure. Twelve cases of persistent vertical strabismus occurred following blepharoplasty procedures. Five patients had clinical findings consistent with the diagnosis of acquired superior oblique palsy; one of these five patients also showed signs of an acquired Brown syndrome. Seven patients developed an incomitant vertical deviation consistent with an inferior rectus paresis. Strabismus occurred after conventional lower lid, upper lid, and four-lid blepharoplasty with or without laser blepharoplasty. Acquired strabismus accompanied by persistent diplopia may occur as a complication of cosmetic blepharoplasty. Extraocular muscle damage resulting in either superior oblique muscle palsy or inferior rectus paresis was noted in these patients. In some cases, patients with inferior rectus paresis also showed mechanical restriction to upward rotation of the globe.

Isolated inferior rectus paresis secondary to a mesencephalic cavernous angioma

PURPOSE: To report a case of recurrent binocular, vertical diplopia presenting as an isolated, unilateral inferior rectus paresis occurring in a patient with a mesencephalic tegmental cavernous angioma. METHOD: Case report. A 30-year-old man with recurrent vertical diplopia underwent neuro-ophthalmic examination, laboratory examination, pharmacologic testing, and magnetic resonance imaging and angiography. RESULTS: Magnetic resonance imaging disclosed a lesion in the mesencephalon consistent with a cavernous angioma. Magnetic resonance angiography was negative. CONCLUSIONS: Isolated inferior rectus paresis is a rare phenomenon. This unique case involved a patient with recurrent inferior rectus paresis secondary to a mesencephalic cavernous angioma. The disparity between the extent of the lesion and the neuro-ophthalmologic consequences is remarkable.

Congenital Absence of the Inferior Rectus Muscle

A healthy 4-year-old boy was seen because of a history of pronounced right head tilt. Surgical exploration demonstrated absence of the right inferior rectus muscle. Both horizontal recti muscles were transposed to the normal insertion of the inferior rectus muscle. Six months postoperatively, the boy was orthophoric in the primary and reading positions. Clinical findings in congenital absence of the inferior rectus may mimic those of an inferior rectus paresis. Orbital computed tomography can assist in the diagnosis.

Isolated Inferior Rectus Paresis as the Presenting Manifestation of Myasthenia Gravis

Isolated Inferior Rectus Paresis as the Presenting Manifestation of Myasthenia Gravis

Myasthenia Gravis Presenting as an Isolated Inferior Rectus Paresis

Myasthenia Gravis Presenting as an Isolated Inferior Rectus Paresis