Double elevator palsy (DEP) currently known as Monocular Elevation Deficit is a rare condition characterized by restricted elevation of one eye in all positions of up gaze. Clinically it presents as a unilateral restriction of superior rectus (SR) and inferior oblique (IO). We present a case report of DEP in 3 year old boy who presented with sudden onset of DEP in right eye in our OPD. Very little information on acquired causes of DEP is available. Diagnosis, differential diagnosis and management are discussed and then the literature is reviewed.
KEYWORDS: DOUBLE ELEVATOR PALSY (DEP), MONOCULAR ELEVATION DEFICIT (MED), UPGAZE PALSY.INTRODUCTION: Double elevator palsy (DEP) is a rare condition which was first described by White in 1942 and later by Dunlap. 1 In DEP there is apparent paralysis of the elevators of one eye, the superior rectus and inferior oblique resulting in restricted elevation. DEP is actually a misnomer because true paralysis of the elevator muscles is seen only one-fourth of cases and mostly only one of the elevator muscles may be involved in certain cases. Hence DEP is better known as Monocular Elevation Deficit (MED) 2 .
Schwannomas constitute about 8% of all intracranial tumors and commonly arise from the vestibulocochlear and trigeminal nerves. Motor nerve schwannomas arising from the oculomotor nerve are very rare. Currently, there are approximately 38 well-documented cases of isolated oculomotor nerve schwannoma reported in the literature worldwide. The management of these large tumors is especially challenging given the proximity of these tumors to the cranial nerves and the brainstem. This article presents a 10-year-old girl with isolated cisternal oculomotor nerve schwannoma causing parent nerve dysfunction.
Background: Pterygium is defined as a triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over limbus onto the cornea. Commonly seen among farmers, fishermen, stone cutters and welders. Both blue and ultraviolet light have been implicated in its causation. Histologically the true Pterygium shows elastotic degeneration of the subconjunctival connective tissue. Pterygium warrant treatment when they encroach the visual axis, induces significant astigmatism or become cosmetically bothersome. My present study was undertaken to evaluate the efficacy, safety and recurrence rates of conjunctival autograft and bare sclera techniques in treatment of progressive true pterygium in a rural hospital.Methods: The prospective study was done in the Department of Ophthalmology, Adichunchanagiri Institute of Medical Sciences, B.G Nagara, Mandya District, Karnataka, India. The study was conducted for a period of 18 months. About 70 patients who presented with progressive pterygium were included in the study.Results: In our study pterygium recurred in 10 cases (14.28%), among which pterygium recurred in 8 cases (22.85 %) using bare sclera technique and in 2 patients (5.71%) using conjunctival autograft technique, best corrected visual acuity remained stable in 37 cases (52.85 %), improved in 33 cases (47.14 %) and worsened in none (0%) of the cases.Conclusions: Conjunctival autografting is a safe and effective procedure in the management of pterygium. The recurrence rate following limbal conjunctival autografting is significantly lower than that following primary conjunctival closure by bare sclera technique.
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