Effects of innervational strabismus surgery on a patient with hypotropic strabismus and pseudoblepharoptosis

We seek to analyze the results of the innervational surgery in a case of hypotropia with peudoptosis with vidiooculography (3D-VOG).

We present the clinical case of a 35 year old male suffereing from acquired ptosis of the left eyelid, present since the age of 10 and who was interested in cosmetic surgery. The preoperative 3D-VOG shows hypotropia of the left eye (22.5 degrees), minimum exotropia and intorsion together with limitation in the elevation of the left eye with positive passive duction test and pseudoptosis.

Surgery was carried out in three stages: 1. Recession of the superior rectus of the right eye (RE) resulting in an improvement in the elevation and the pseudoptosis; 2. Recession of the inferior rectus of the left eye (LE), with improvement in the elevation of the LE but deterioration of the pseudoptosis; 3. Resection of the inferior rectus of the RE which improves both the elevation as well as the pseudoptosis of the LE.

We consider the usefulness of the innervational techniques in the incomplete third nerve paralysis with important affectation in the elevation, making it necessary to check and in this case eliminate the restrictive effects although this may influence the effect on the pseudoptosis.