DR. POORNIMA GOLTHI

DR. RAMAN YENUGANDULA

Abstract

15 year old boy came with a chief complaint of decrease in the vision for far since 4 months.No history of usage of spectacles and no asthenopic symptoms.on general examination,there is a preauricular tag on the left side,laxity in the joints,arachnodactyly,disproportionate long arm and legs,tall and slender built,wrist sign positive,thumb sign positive

Ocular examination: Both eyes vision is 6/18 improving to 6/9.Anterior segment of both eyes is normal.on post dilated examination superonasal subluxation of lens noted.orthoptic examination shows head tilt towards left side.

Alternate cover test showing on covering alternate eye both eye moving out to take fixation suggestive of alternate esotropia

Extra ocular movements:limitation of left eye abduction and on adduction of left eye narrowing of palpabrel fissure and widening of palpebral fissure on abduction of left eye.convergence weakness present for left eye but adduction of left eye normal.