Strabismus pp 267-284 | Cite as

Miscellaneous Strabismus Syndromes

  • Burton J. Kushner


The original term for this condition was double-elevator palsy , because it was felt to be due to a paralysis of both the ipsilateral superior rectus muscle (SR) and inferior oblique muscle (IO). We now recognize that it can be caused by inferior rectus muscle (IR) restriction in isolation [1, 2], supranuclear causes [3, 4], or paralysis of the SR without ipsilateral IO weakness [2, 3, 4]. There also can be IR restriction secondary to ipsilateral SR paresis. It is characterized by an inability to elevate above the midline in all horizontal gaze fields.


Aqueous drainage device Congenital fibrosis of the extraocular muscles Craniofacial syndromes Craniosynostosis Flap tears Forced duction Knapp procedure Marcaine myotoxicity Monocular elevation deficiency (MED) Monocular elevation deficiency Myasthenia gravis Orbital floor fracture Presbyopia Scleral buckling surgery Seton Sinus surgery Spring-back test Superior oblique myokymia Thyroid eye disease (TED) 


  1. 1.
    Scott WE, Jackson OB. Double elevator palsy: the significance of inferior rectus restriction. Am Orthopt J. 1977;27:5–10.CrossRefGoogle Scholar
  2. 2.
    Metz HS. Double elevator palsy. Arch Ophthalmol. 1979;97:901–3.CrossRefGoogle Scholar
  3. 3.
    Jampel RS, Fells P. Monocular elevation paresis caused by a central nervous system lesion. Arch Ophthalmol. 1968;80:45–57.CrossRefGoogle Scholar
  4. 4.
    Fells P, Jampel RS. Supranuclear factors in monocular elevation palsy. Trans Ophthalmol Soc UK. 1970;90:471–81.PubMedGoogle Scholar
  5. 5.
    Kushner BJ. Case report. Ocular muscle fibrosis following cataract extraction. Arch Ophthalmol. 1988;106:18–9.CrossRefGoogle Scholar
  6. 6.
    Hunter DG, Lam GC, Guyton DL. Inferior oblique muscle injury from local anesthesia for cataract surgery. Ophthalmology. 1995;102:501–9.CrossRefGoogle Scholar
  7. 7.
    Kushner BJ. Superior oblique tendon incarceration syndrome. Arch Ophthalmol. 2007;125:1070–6.CrossRefGoogle Scholar
  8. 8.
    Kushner BJ. The inferior oblique muscle adherence syndrome. Arch Ophthalmol. 2007;125:1510–4.CrossRefGoogle Scholar
  9. 9.
    Metz HS. Double elevator palsy. J Pediatr Ophthalmol Strabismus. 1981;18:31–5.PubMedGoogle Scholar
  10. 10.
    Knapp P. The surgical treatment of double-elevator palsy. Trans Am Ophthalmol Soc. 1969;67:304–23.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Struck MC, Larson JC. Surgery for supranuclear monocular elevation deficiency. Strabismus. 2015;23:176–81.CrossRefGoogle Scholar
  12. 12.
    Ludwig IH, Brown MS. Strabismus due to flap tear of a rectus muscle. Trans Am Ophthalmol Soc. 2001;99:53–62; discussion-3.Google Scholar
  13. 13.
    Ludwig IH, Brown MS. Flap tear of rectus muscles: an underlying cause of strabismus after orbital trauma. Ophthal Plast Reconstr Surg. 2002;18:443–9. discussion 50.CrossRefGoogle Scholar
  14. 14.
    Ludwig IH, Clark RA, Stager DR Sr. New strabismus surgical techniques. J AAPOS. 2013;17:79–88.CrossRefGoogle Scholar
  15. 15.
    Kushner BJ. Paresis and restriction of the inferior rectus muscle after orbital floor fracture. Am J Ophthalmol. 1982;94:81–6.CrossRefGoogle Scholar
  16. 16.
    Salama H, Farr AK, Guyton DL. Anesthetic myotoxicity as a cause of restrictive strabismus after scleral buckling surgery. Retina. 2000;20:478–82.CrossRefGoogle Scholar
  17. 17.
    Zhang C, Phamonvaechavan P, Rajan A, Poon DY, Topcu-Yilmaz P, Guyton DL. Concentration-dependent bupivacaine myotoxicity in rabbit extraocular muscle. J AAPOS. 2010;14:323–7.CrossRefGoogle Scholar
  18. 18.
    Capo H, Guyton DL. Ipsilateral hypertropia after cataract surgery. Ophthalmology. 1996;103:721–30.CrossRefGoogle Scholar
  19. 19.
    Kushner BJ. Extraocular muscle contracture and overaction syndrome occurring after periocular anesthesia. J AAPOS. 2004;8:182–3.CrossRefGoogle Scholar
  20. 20.
    Kushner BJ. Unexpected cyclotropia simulating disruption of fusion. Arch Ophthalmol. 1992;110:1415–8.CrossRefGoogle Scholar
  21. 21.
    Jampolsky A. Surgical leashes and reverse leashes in strabismus management. In: Transactions of the New Orleans Academy of Opththalmology. St. Louis: Mosby; 1978. p. 244–68.Google Scholar
  22. 22.
    Underdahl JP, Demer JL, Goldberg RL, Rosenbaum AL. Orbital wall approach with preoperative orbital imaging for identification and retrieval of lost or transected extraocular muscles. J AAPOS. 2001;5:230–7.CrossRefGoogle Scholar
  23. 23.
    Engle EC, Goumnerov BC, McKeown CA, Schatz M, Johns DR, Porter JD, Beggs AH. Oculomotor nerve and muscle abnormalities in congenital fibrosis of the extraocular muscles. Ann Neurol. 1997;41:314–25.CrossRefGoogle Scholar
  24. 24.
    Lim KH, Engle EC, Demer JL. Abnormalities of the oculomotor nerve in congenital fibrosis of the extraocular muscles and congenital oculomotor palsy. Invest Ophthalmol Vis Sci. 2007;48:1601–6.CrossRefGoogle Scholar
  25. 25.
    Weiss AH, Phillips JO. Hypertropia associated with superolateral translation of the superior rectus muscle pulley in unilateral coronal synostosis. Arch Ophthalmol. 2006;124:1128–34.CrossRefGoogle Scholar
  26. 26.
    Wright WW, Gotzler KC, Guyton DL. Esotropia associated with early presbyopia caused by inappropriate muscle length adaptation. J AAPOS. 2005;9:563–6.CrossRefGoogle Scholar
  27. 27.
    Ellis FD, Hoyt CS, Ellis FJ, Jeffery AR, Sondhi N. Extraocular muscle responses to orbital cooling (ice test) for ocular myasthenia gravis diagnosis. J AAPOS. 2000;4(5):271–81.CrossRefGoogle Scholar
  28. 28.
    Acheson JF, Elston JS, Lee JP, Fells P. Extraocular muscle surgery in myasthenia gravis. Br J Ophthalmol. 1991;75:232–5.CrossRefGoogle Scholar
  29. 29.
    Davidson JL, Rosenbaum AL, McCall LC. Strabismus surgery in patients with myasthenia. J Pediatr Ophthalmol Strabismus. 1993;30:292–5.PubMedGoogle Scholar
  30. 30.
    Agarwal S, Kushner BJ. Results of extraocular muscle surgery for superior oblique myokymia. J AAPOS. 2009;13:472–6.CrossRefGoogle Scholar
  31. 31.
    Kushner BJ. Ocular torsion: rotations around the “WHY” axis. J AAPOS. 2004;8:1–12.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Burton J. Kushner
    • 1
  1. 1.Department of Ophthalmology and Visual SciencesUniversity of Wisconsin-MadisonMadisonUSA

Personalised recommendations