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October 1964


Author Affiliations

33 College Ave, Waterville, Me 04901

Arch Ophthalmol. 1964;72(4):577. doi:10.1001/archopht.1964.00970020577026

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To the Editor:  Dr. Jack Goldstein's recent paper (Arch Ophthal 72:5-8 [July] 1964) calls our attention to the interesting clinical observation of isolated paresis of the superior rectus muscle in association with dysfunction of the thyroid. Although he indicates that, "In some situations a forced duction test may be useful," in none of the four cases reported is the result of such a maneuver noted. While I do not doubt the validity of the clinical observations made, I must confess that I would feel more secure in the diagnosis of at least some of these cases had the forced duction test been performed.To speculate for a moment, it seems plausible to me that the inferior rectus may become selectively involved by the infiltrative process seen in dysthyroidism because of its location in the lowest part of the orbit. Because the infiltrated and/or fibrotic inferior rectus cannot relax adequately on

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