Dr.Divya Kishore, D17623
CCDDs involving 3rd and 4rth nerve nucleus/ nerve / innervated muscles are classed as CFEOM. We report 2 CCDDs without fibrosis simulating unilateral congenital 3rd nerve palsy. Cryptorchidism and absent kidney also noted. Right eye was involved in both cases. Case 1, 8 years old boy had synergistic divergence, PP hypotropia, ptosis and large exotropia. Vertical divergence was noted with synergistic divergence, on attempted upgaze large eso occurred and on down gaze large exo. Upgaze evoked extorsion right eye and intorsion left eye noted with left eye right gaze evoked jerk nystagmus and see saw nystagmus on left gaze. MRI showed hypoplastic medial rectus muscle. Sixteen years old boy had superior division 3rd nerve palsy with MGP on mouth opening, jaw movements and on teeth clenching. Phenylephrine 1% enhanced MGP. Fibrosis of extraocular muscles absent. Such CCDDs may harbor prenuclear / supranuclear involvement with dysinnervation and masquerade as congenital 3rd nerve palsies.
Leave a Comment