FP749 : Case of isolated inferior rectus aplasia in an eleven year old

Dr.Shilpa Rao, R17995

Synopsis- A healthy 11 year old boy, no prior trauma presented with diminished vision and upward deviation of right eye since birth. On examination he had best corrected vision of 6/18 in right eye, right head tilt, 25 prism dioptres of right hypertropia in the primary position, -4 limitation of dextrodepression and right suppression on WFDT. MRI was deferred (no affordability) . He was provisionally diagnosed with inferior rectus(IR) palsy and advised superior rectus(SR) recession with IR plication. Intraoperatively, FDT was negative and exploration revealed total IR aplasia. Surgical plan was revised to hemihangback recession of SR (10 mm) alone. Postoperatively he had good alignment with 5pd right hypertropia, on review. In addition to familial cases / syndromes, isolated IR aplasia must be considered as a differential diagnosis of hypertropia and exploration of IR intraoperatively should be done first prior to operating on other muscles.