[Unilateral paralysis of the levator muscles]

Double elevator palsy is rare clinical disorder of ocular motility characterised by a unilateral palsy of the superior rectus and inferior oblique with a resultant inability or reduced ability to elevate the affected eye on abduction as well as on adduction. The term double elevator palsy has been used to describe clinical cases that certainly do not have the features of the true paralysis. It is useful to distinguish between: true double elevator palsy characterised by hypotropia of the paretic eye in primary gaze, by a limitation of elevation in abduction and in adduction, by a negative forced duction test and by presence of Bell phenomenon; the clinical form in which prolonged hypotropia has produced a contracture of the ipsilateral antagonist; isolated inferior restriction combined with limitation of elevation and normal elevator muscle function. The clinical case reported is that of a patient suffering from a right double elevator paralysis, probably congenital, corresponding to Type 1 of White's classification.