Congenital absence of the superior rectus muscle: a case report

We report a case of bilaterally absent superior rectus muscles presenting clinically as a double elevator palsy. This patient is unique due to paradoxical ocular movements on attempted upgaze and the absence of other major craniofacial anomalies. Successful surgical correction was accomplished using a modified Jensen procedure where the superior halves of the horizontal rectus muscles were united using synthetic absorbable sutures. Congenital absence of the superior rectus muscles should be suspected in patients with severe elevation deficiency associated with paradoxical ocular movements.