Heimann-Bielschowsky phenomenon and hypotropic DVD in case of monocular vision loss: a case report

Abstract

Background: The Heimann-Bielschowsky phenomenon (HBP) is an underrecognized condition characterized by slow, pendular, vertical oscillations of the eye accompanying monocular vision loss. Hypotropic dissociated vertical deviation (DVD) is another rare condition induced by asymmetric visual input. This report documents a rare case of HBP with hypotropic DVD.

Case presentation: This report describes a case of a 58-year-old woman with HBP and hypotropic DVD, having suffered monocular vision loss in the left eye due to blunt trauma at the age of 10. Preoperatively, she was orthophoric at near fixation and demonstrated an intermittent, slow hypotropia of the left eye upon distance fixation that never rose above the midline. She underwent a 7 mm recession of the inferior rectus muscle in the left eye. After surgery, intermittent, downward drifts became constant vertical oscillations at both distance and near fixation.

Conclusions: This case describes the clinical manifestation of an eye movement disorder related to prolonged monocular vision loss.

Keywords: Case report; Heimann-Bielschowsky phenomenon; Hypotropic DVD; Monocular vision loss.

Fig. 1

Left) Preoperative photograph demonstrating hypotropic DVD of the left eye as the right eye fixates on a distant target. Right) Preoperative photograph demonstrating nearly orthophoric as the left eye fixates on a near target

Fig. 2

Left) Postoperative photograph demonstrating slight hypertropia of the left eye as the right eye fixates on a distant target. Right) Postoperative photography demonstrating orthophoric alignment as the left eye fixates on a near target