May 1979

Double Elevator Palsy

Author Affiliations

From the Smith-Kettlewell Institute of Visual Sciences, San Francisco, and the Department of Ophthalmology, University of Rochester (NY) School of Medicine and Dentistry.

Arch Ophthalmol. 1979;97(5):901-903. doi:10.1001/archopht.1979.01020010459013

• Of 15 patients with monocular limitation of elevation, six had no deviation in primary gaze while the remaining nine had hypotropia of the involved eye. Twelve of 15 patients had restriction to upgaze on forced duction testing. Eleven of these 12 had normal upward saccadic velocity, which suggested normal elevator function. Four patients had reduced saccadic velocity, which indicated true elevator weakness. Superior rectus muscle paresis alone could account for limited elevation and would reduce upward saccadic speed. Patients with a diagnosis of "double elevator palsy" only infrequently (about one quarter of cases) have palsy of an elevator muscle and may have only a single elevator palsy. The identification of a true elevator weakness is most important in planning management.