Bilateral hypotropic dissociated vertical deviation: a case report

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus Research

Background:

• Hypotropic dissociated vertical deviation (DVD) is a rare strabismus subtype.
• Unlike common hypertropic DVD, hypotropic DVD is seldom reported.
• This case presents a unique combination of bilateral hypotropic DVD with other ocular conditions.

Observation:

• A 4-year-old girl presented with bilateral hypotropic DVD, intermittent exotropia, and manifest latent nystagmus.
• The hypotropic DVD was only apparent when one eye was covered.
• The patient underwent bilateral lateral rectus recession and inferior oblique recession.

Findings:

• The patient exhibited bilateral hypotropic DVD, intermittent exotropia, manifest latent nystagmus, and anomalous head posture.
• Post-surgery, the patient achieved orthophoria in primary gaze with normal head posture.
• The hypotropic DVD remained unchanged by surgery, indicating it did not require surgical correction.

Implications:

• This case expands the understanding of rare hypotropic DVD presentations.
• It highlights that hypotropic DVD may not always necessitate surgical intervention.
• Inferior oblique recession appears safe and does not negatively impact hypotropic DVD appearance.