Paralysis of both elevators of one eye, although one of the less common paralyses, is seen not infrequently and is generally if not always congenital. The paralysis of both muscles is more or less well defined; usually the inferior oblique is the more paretic of the two.
Such paralysis limits elevation throughout the whole upper field, in the temporal field owing to the underaction of the superior rectus muscle and in the nasal field owing to the underaction of the inferior oblique muscle.
There may be true ptosis or pseudoptosis accompanying the paralysis. The true ptosis is due to paralysis of the levator muscle. The pseudoptosis is brought about because the lid of the paretic eye follows the eye down much as both lids do normally when the eyes are fixating in the lower field. Either true or false ptosis may be exaggerated in order to prevent diplopia.
WHITE JW. PARALYSIS OF THE SUPERIOR RECTUS AND THE INFERIOR OBLIQUE MUSCLE OF THE SAME EYE. Arch Ophthalmol. 1942;27(2):366–371. doi:10.1001/archopht.1942.00880020152015