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Updated: Jun 6, 2026

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Published on: March 1, 2015

Monocular elevation deficiency ("double elevator" palsy): a cautionary note.

Michael C Brodsky¹, Virginia Karlsson

¹Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. brodsky.michael@mayo.edu

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society

|December 7, 2010

Summary

This summary is machine-generated.

Monocular elevation deficiency, a congenital condition, can present with unusual lower eyelid changes in downgaze. This finding, linked to inferior rectus contracture, may mimic other eye movement issues.

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Area of Science:

Ophthalmology
Pediatric Ophthalmology
Strabismus

Background:

Monocular elevation deficiency (MED), also known as "double elevator" palsy, is a congenital condition characterized by impaired upward eye movement.
This condition typically affects the ability to elevate the eye equally in both adduction and abduction.

Observation:

A case study involving a child diagnosed with monocular elevation deficiency is presented.
The child exhibited unique symptoms of central lower eyelid tethering and buckling specifically during downgaze.

Findings:

The observed lower eyelid changes are attributed to a contracture of the inferior rectus muscle.
This specific manifestation of inferior rectus contracture in the context of MED can be misleading.

Implications:

Clinicians should be aware that inferior rectus contracture in MED can mimic other conditions affecting eye movement.
Accurate diagnosis requires careful observation of eyelid dynamics in conjunction with eye movement assessment.