Double elevator palsy
H. S. Metz
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.
