Dr. Sowbhagya H N, S04767, Dr. Divya Bhargavi
Double elevator palsy or monocular elevation deficiency (MED) is characterized by congenital unilateral defect in elevation of the eye, both in adduction and abduction.Association of marcus gunn jaw winking phenomenon, congenital ptosis and MED indicates congenital misdirection syndrome involving the oculomotor nerve and MED may be due to supra nuclear problem.A 10yrs old boy came to OPD with c/o of Drooping of RE upper eyelid since birth and DOV since 2 yrs. H/o glasses use, patching, trauma or previous ocular surgery, Past medical, family and birth history noted.VA recorded by Snellen chart.Refraction done.Squint evaluation done for both motor and sensory functions.Extra ocular movements assessed. Presence of ptosis, jaw winking phenomenon,Marginal reflex distance palpebral fissure height,levator function, Bell phenomenon and any change in position of the lid on fixation noted. Patients requiring surgical management were counseled about possibility of multiple surgeries according to clinical assessment.On ophthalmic examination BCVA