Apparent inferior rectus palsy with gaze-dependent sensory adaptations

Kimlin, Janessa A., Puglisi, Anna K., Urquhart, Thomas A. and Sampson, Geoff P. 2014, Apparent inferior rectus palsy with gaze-dependent sensory adaptations, Optometry and vision science, vol. 91, no. 6, pp. e140-e144, doi: 10.1097/OPX.0000000000000256.

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Title Apparent inferior rectus palsy with gaze-dependent sensory adaptations
Author(s) Kimlin, Janessa A.
Puglisi, Anna K.
Urquhart, Thomas A.
Sampson, Geoff P.ORCID iD for Sampson, Geoff P.
Journal name Optometry and vision science
Volume number 91
Issue number 6
Start page e140
End page e144
Total pages 5
Publisher Lippincott, Williams & Wilkins
Place of publication Philadelphia, Pa.
Publication date 2014-06
ISSN 1040-5488
Keyword(s) Adaptation, Ocular
Diagnosis, Differential
Diagnostic Techniques, Ophthalmological
Ocular Motility Disorders
Oculomotor Muscles
Oculomotor Nerve Diseases
Young Adult
Summary PURPOSE: This report presents a case of apparent congenital inferior rectus palsy notable for sensory adaptations that appeared to vary with direction of gaze. It is shown that readily available clinical tests and an understanding of the physiology of ocular motility can be used to help distinguish from differential diagnoses such as contralateral inferior oblique palsy or the more commonly seen Brown syndrome.
CASE REPORT: A 20-year-old male optometry student reported strabismus that had been noted at birth and was diagnosed as Brown syndrome in childhood. The Parks three-step test showed primary gaze hypertropia that increased in left gaze but the "third step" (Bielschowsky head tilt test) was not successful in establishing the apparently correct diagnosis, which was later confirmed by a Hess screen. A proposed "fourth" step by Bajandas proved to be more accurate in this case of inferior rectus palsy. Sensory tests revealed adaptation patterns that varied with gaze direction and showed a cyclotorsional element. The patient reported being relatively unconcerned about his condition as he seemed to be able to voluntarily use a form of shallow suppression to reduce awareness of diplopic images.
CONCLUSIONS: Although it is common to consider suppression and retinal correspondence status as hardwired and relatively constant for an individual patient, this case demonstrates that these sensory adaptations are likely to be far more complex and transitory. An understanding of both motor and sensory repercussions of ocular motility dysfunction assists differentiation between benign and sinister causes of nonconcomitant strabismus.
Language eng
DOI 10.1097/OPX.0000000000000256
Field of Research 111399 Ophthalmology and Optometry not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2014, American Academy of Optometry
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