DR.NITHYA R.

DR. ABDUL BOLAR, DR. ROHIT SHETTY, DR.BHANUMATHI

Abstract

Case : 17 yr old boy presented to us with Complaints of diplopia only in right and downgaze(noticed while shaving)since a few days,He was diagnosed as right lateral rectus palsy elsewhere.

On examination,patient’s vision was 6/6p in OD and 6/6 in OS,squint evaluation revealed 5degree Esotropia in right eye In primary position and -1 limitation of abduction in right eye and right suppression.

Though initial suspicion was lateral rectus palsy,

MRI brain plain was normal, contrast revealed a thin fibrotic band connecting right lateral rectus and inferior rectus suggestive of restrictive pathology.

Presense of suppression gave us a clue that it could be a congenital / long-standing problem.

Through this case report we emphasise that there is a possibility of restrictive pathology mimicking a nerve palsy.

Conclusion: careful MRI evaluation(both plain and contrast) with help of neuroradiologist is essential to diagnose such rare restrictive pathologies which can mimic a nerve palsy.