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Case of the week 57 (
May 2012 )
Fixation with the paretic eye : Right Superior
oblique palsy
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This
22 years old patient complaint is the xt and ptosis of
his
Lt. eye , he also noticed that his left eye is
slightly lower than the right eye
He told me that he had done Lasik for his left
eye 6 months ago to correct unilateral myopia ,
He doesn't know his preoperative readings , but
he said that his left eye was amblyopic due to
anisometropia since childhood , Lasik surgery
doesn't improve the amblyopia , VA still as the
same as preoperative .
Two ophthalmologist have examined him separately
, they reported the same ( Lt. XT , ptosis and
Hypotropia ... for recessing Lt. LR and
Resecting Lt. SR )
Do You agree
with them ?
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I've consulted prof dr Eugene Helvestone
about this case
Dear Sir ,
this patient complaint is the xt and ptosis of
his Lt. eye , he also noticed that his left eye
is slightly lower than the right eye
He told me that he had done Lasik for his left
eye 6 months ago to correct unilateral myopia ,
He doesn't know his preoperative readings , but
he said that his left eye was amblyopic due to
anisometropia since childhood , Lasik surgery
doesn't improve the amblyopia , VA still as
preoperative when he wore his contact lens
Two ophthalmologist have examined him separately
, they reported the same ( Lt. XT , ptosis and
Hypotropia ... for recessing Lt. LR and
Resecting Lt. SR ) ,
I completely disagree with them
I see this is too much surgery for the wrong eye
I feel this patient has Rt. SO palsy class I
with inhibitional palsy of the cotralateral
antagonist leading to this pseudoptosis of the
Lt. levator ms
Since the normal eye was amblyopic since
childhood due to anisometropia he is always
fixing with the diseased Rt. eye ,this leads to
hypotropia of the Lt.eye even in the primary
position ( On OD transoccluder picture you can
see the hypertropia of the Rt. eye which is the
classic finding of SO palsy on fixing with the
normal eye )
It is class I because the most hyperdeviation
gaze is on lookig Lt. ( picture 6 )
My surgical decision is
Only Rt.IO Myectomy
Here is the answer
Dear Dr. Sobhy,
I agree with you. It is always difficult to
convince a patient that he needs surgery on what
he (the patient) had been told and continues to
assume is the "normal" eye. You might show the
patient the right hyper in right head tilt, but
that probably would not convince him.
The only thing you can do is continue to do the
right thing.
Good luck, great job with this case.
Dr. Eugene Helveston
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