A Case of Congenital Oculomotor Nerve Palsy with Synergistic Divergence

Choi, Hee Young; Lee, Jung Hoon

Abstract

PURPOSE: To report a case of unilateral oculomotor nerve palsy with synergistic divergence.
METHODS
A 30-year-old man presented with outward and downward deviation of the right eye, ptosis of both eyes, and abnormal eyeball movement on left gaze since birth. His corrected visual acuity was 0.1 in the right eye and 0.7 in the left eye, indicating amblyopia in the right eye. Both eyes had high myopia of 10 diopter. In the primary position, there was a right exotropia of 70 prism diopter (PD) and hypotropia of 20 PD at both near and distance, accompanying ptosis of both eyes. Ocular motility examination revealed the absence of adduction in the right eye and the supraduction difficulties in both eyes, with a simultaneous abduction of both eyes on levoversion. The electrooculographic record of the patient showed that the movement of the right eye is always opposite to that of the left eye on levoversion. We performed lateral rectus recession 10 mm, medial rectus tucking 8 mm, and inferior rectus recession 3 mm in the right eye. Postoperatively, exotropia and hypotropia was reduced to each 10 PD and 4 PD, but there was no improvement of synergistic divergence.
RESULTS
This case is thought to be a synergistic divergence combined with the oculomotor nerve palsy. The horizontal muscle surgery reduced the exotropia but did not improve the synergistic divergence in this patient.