Dr. Smita Kapoor

DR.SHREYA GUPTA

Abstract

A 26 year old female presented with drooping of left upper lid since childhood. On examination she had a head tilt to left shoulder, pseudoptosis, hypotropia in the left eye and a large secondary hyperdeviation in the right eye. There was overaction of left superior oblique and underaction of the inferior oblique muscle. On performing a prism cover test, a V pattern was noted. Thus a diagnosis of congenital Brown’s syndrome was made. Bielschowsky head tilt test was positive for (OS) IO and on performing forced duction test, there was no restriction of elevation in adduction, thus a diagnosis of left inferior oblique palsy with V pattern was made. The primary deviation was 25 PD hypotropia and 15 PD exotropia. She underwent (OS) PTSO, (OD) LR recession and SR recession. The head posture and ptosis improved postoperatively and she became orthotropic in primary gaze. Only one case with a ‘V’ pattern in IO palsy has been reported in literature. We describe its successful management here.