I fear that my ptosis and strabismus cannot be corrected. Please help.

Question

Hello doctor,

I am 26 years old. I am working in software field. I do have problems of ptosis and strabismus in my left eye since birth. I am not able to see with this eye until I forcefully close my right (dedicated) eye. I got operated for ptosis when I was 11, and it got recovered a lot. But, strabismus remains the same, and it affects my life a lot due to the cosmetic reason. I could not get socialized and try to avoid society. I had a lot of consultations with local doctors. Let me share my last meeting and my conclusion. According to my local doctor, my upper lift muscle is dead by birth, and it cannot be restored ever. I have to stop thinking about fixing it. If surgery fixes it, then it will never appear as parallel as the right (dominant eye). Also, now my brain is receiving (single) right eye's image, and after surgery, my brain will receive two images. But, it will be difficult to focus on any of them. He also said that superior rectus muscle or inferior oblique muscle of left eye has stopped working or affected after my eyelid operation or those are dead by birth cause, and there is nothing to pull the eyeball upwards. The eyeball does not move and focus towards upwards and outwards. Also, he mentioned about Brown syndrome. If this is a Brown syndrome, then the left lower eye that is affected, tethered or held down by the tight superior oblique tendon muscle. If this is true, then, in this case, the eye neither moves upward nor inwards towards the nose. But, my left eye moves inwards, but difficulty with moving outwards. Please clarify my doubts

Answer 1

Hi,

Welcome to icliniq.com.

You have double elevator palsy. It is also known as monocular elevation deficit with ptosis. You are right in saying that superior rectus and inferior oblique muscles are non-functioning. The only treatment is surgery. We operate squint first, and Knapp surgery is required. Here, we transpose horizontal muscles (medial rectus and lateral rectus) to the inner and outer margin of superior rectus. This helps in decreasing hypotropia, and the eye movement is less affected. We wait for six months to get a full effect of surgery, and then we operate lid for ptosis surgery (Tarsofrontalis sling) and it is the best option. Sometimes, we can prescribe crutch glasses if the patient does not want ptosis surgery. So do not lose hope. Squint can be treated with your case, and ptosis surgery can be revised.