Isolated Bilateral Superior Rectii Paresis: A Rare Anomaly

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus Surgery

Background:

• Bilateral isolated superior rectus paresis is a rare condition affecting eye movement.
• This case highlights a unique presentation of alternating exotropia and hypertropia.

Observation:

• A 13-year-old girl presented with bilateral superior rectus paresis, characterized by impaired elevation in abduction.
• Overaction of the inferior obliques (contralateral yoke muscles) was noted.
• Neuroimaging ruled out third nerve pathway lesions or superior rectus muscle hypoplasia.

Findings:

• Surgical correction involved bilateral lateral rectus recession and bilateral inferior oblique myectomy.
• The patient achieved excellent alignment and functional recovery 1 year post-surgery.

Implications:

• This case underscores the importance of identifying and managing rare extraocular muscle palsies.
• The successful surgical strategy provides a potential treatment approach for similar rare strabismus cases.
• This is the first reported case of isolated superior rectus paresis in Pakistan.