Bilateral asymmetric dissociated vertical deviation masquerading as unilateral double elevator palsy. A report of four cases

Abstract

Purpose: To illuminate this difficult clinical situation and assist and improve in its diagnosis and management. METHODS AND STUDY: Record Review. All 4 patients had a unilateral DEP and increased hyperdeviation upon tilting the head to the contralateral shoulder. Two patients had surgery to the eye with the presumed diagnosis of DEP, consisting of recession of the inferior rectus muscle in one patient and a Knapp procedure in the second patient. The other two patients had weakening surgery of the superior rectus muscle of the contralateral eye.

Results: The marked limitation of elevation in the eye with pseudo- DEP was either restored to normal or very satisfactorily improved. Bilateral DVD appeared in all four patients immediately after surgery.

Conclusion: Bilateral asymmetric DVD can masquerade as unilateral DEP due to inhibitional palsy of the elevators. Meticulous diagnostic tests can reveal the DVDs.