Parálisis aislada del músculo oblicuo inferior izquierdo

La parálisis aislada del músculo oblicuo inferior constituye la parálisis menos frecuente de todas las que afectan a los músculos extraoculares. Se realiza la presentación de una paciente de seis años de edad con antecedentes de salud que fue traída por su madre a la consulta de oftalmología pediátrica y estrabismo por presentar una desviación ocular desde los primeros meses de nacida. Se planteó como posibles diagnósticos un síndrome de Brown del ojo izquierdo o una parálisis del músculo oblicuo inferior izquierdo, se confirmó el segundo diagnóstico con el test de ducción forzada. Existen varias opciones quirúrgicas para estos pacientes. El objetivo fue determinar si se logra el alineamiento quirúrgico en la posición primaria de mirada con la intervención quirúrgica propuesta de recesión del recto superior derecho 5 mm. La paciente se encuentra alineada en posición primaria de mirada, sin limitación de las versiones y sin tortícoli.

Isolated palsy of the inferior oblique muscle is the least frequent of all palsies affecting the extraocular muscles. We present a six-year-old female patient with a medical history who was brought by her mother to the pediatric ophthalmology and strabismus clinic because she presented an ocular deviation since the first months of her life. A Brown's syndrome of the left eye or left inferior oblique muscle palsy was proposed as possible diagnoses, the second diagnosis was confirmed with the forced duction test. There are several surgical options for these patients. The objective was to determine if surgical alignment in the primary gaze position is achieved with the proposed surgical intervention of right superior rectus recession 5 mm. The patient is aligned in the primary gaze position, without limitation of the versions and without torticollis.

A case of congenital inverse Duane's retraction syndrome

Inverse Duane's retraction syndrome is very uncommon. Congenital cases are even more unusual. A 6-year-old girl with convergent squint along with severe restriction on abduction is described. On attempted abduction, a narrowing of the palpebral fissure, upshoot and retraction of the eyeball were observed. Brain and orbit MRI demonstrated no intracranial or intraorbital mass, fracture, or entrapment of the medial rectus. Forced duction test was strongly positive. The primary lesion was found to be a tight medial rectus with shortening and soft tissue contracture. Surgical tenotomy of the medial rectus led to successful postoperative motility, but some limitation at full adduction and abduction persisted. This is a case reported with congenital medial rectus shortening, suggesting that this condition may be one of the etiologies of the rare inverse Duane's retraction syndrome.

Differential Diagnosis of Atypical Brown Syndrome and Primary Inferior Rectus Restriction of Double Elevator Palsy

Both atypical Brown syndrome (ABS) and inferior rectus restriction of double elevator palsy (DEP) are characterized by monocular limitations of upgaze in primary, abducted position as well as abducted position. Futhermore, they exhibit resistance of elevation in adduction during forced duction test and should be considered in the differential diagnosis. We gained several differential points from 6 year-old female with ABS and a 12 year-old female with DEP due to inferior rectus restriction (IRR). In forced duction test under general anesthesia, ABS exhibited resistance of elevation in adduction and IRR of DEP showed resistance of elevation in all upward direction. DEP showed an impairment of Bell`s phenomenon and mild pseudoptosis preoperatively in which ABS never showed. ABS displayed divergence in upgaze producing V-pattern, and further limitation of upgaze in adduction than DEP. Superior oblique lengthening procedure using silicone expander was performed for ABS. Ipsilateral inferior rectus and contralateral superior rectus recession were performed for IRR of DEP. The results for elevation in adduction, primary position and abduction were satisfactory in both diseases. In conclusion, the direction of resistance in forced duction test, Bell` s phenomenon, the degree of elevation in abducted and abducted position, presence of pseudoptosis and divergence in upgaze producing 3 V-pattern may be helpful to differentiate ABS from IRR of DEP.

The Clinical Study of Treatment of Blowout Fracture

The orbital blowout fractures has been increasing due to trauma and traffic accidents with time. The diagnostic confirmation is easily established by CT scan, but the indication for surgical treatment, the technique for repair, and timing of repair are still controversial. We have reviewed investigated the charts of 18 cases who had blowout fracture, including the clinical manifestation, surgical indication, surgical procedures, improvement of diplopia, and its complication. The follow up was at least 6 months in the past 5 years. In cases of diplopia only in the upward gaze limitation, or small orbital fracture in orbital CT scan and less degree of enophthalmos, these 8 cases were treated conservatively for 2 weeks and diplopia improved markedly. However, in 10 cases of severe diplopia and in large fracture and tissue incarceration, these were surgically managed using Silastic sheets. In these cases, the diplopia resolved within 1 month in 7 cases(70%). Residual diplopia waS seen in 3 cases, and we retreated surgically for the two cases of them. In the other non surgical cases, diplopia resolved on 6 months follow up except in 2 cases of mild diplopia. Therefore we should pay more attention to surgical indication.

A Case of Acquired Brown's Syndrome Caused by Tenosynovitis

Brown's syndrome is characterized by inability to elevate the adducted eye and positive forced duction test. It is known as congenital disease but may occur as acquired disease Acquired Brown's syndrome may occur after superior oblique muscle tucking, frontal sinusitis, surgery of frontal sinus or orbit, scleral buckling, and inflammation in trochlear area. Brown's syndrome caused by inflammation of trochlear area is frequently combined with rheumatoid arthritis. The ocular motiliy is improved after systemic corticosteroid treatment or local injection of corticosteroid in trochlear area. An llyear old korean girl was found to have bilateral aquired Brown's syndrome caused by tenosynovitis. There were severe limitation of elevation in adduction and resistance in forced duction test in both eyes. The ocular motility was improved after local injection of dexamethasone in trochlear area.