Recurrent unilateral restrictive elevation deficit in childhood: a tailored approach

Monocular elevation deficiency poses a challenge to strabismus surgeons on account of its varied clinical presentations as well as management which often needs a tailored approach. We report on a young child who presented to us at 6 months of age with a clinical course marked by primary involvement of the inferior rectus muscle in one eye causing restricted elevation in all gazes and complete relief of hypotropia following disinsertion of the affected muscle but followed by recurrence and additional procedures (antimitotic application and superior rectus plication) for the same. She followed a recalcitrant clinical course which was marked by multiple recurrences requiring a tailored approach and finally managed successfully with a follow-up of 3 years, by now. This case demonstrates the almost intractable nature of restrictive pathology involving a single muscle warranting multiple surgeries and a close follow-up with good surgical outcome.