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Volume 43, 1993, p. 5458

Double Elevator Palsy: Is There a Restriction? (Abstract)
Henry S. Metz, M.D.


"Double elevator palsy" is the clinical designation Often applied to patients with monocular limitation of elevation in both abduction and adduction. When this limitation is secondary to orbital floor fracture or thyroid Ophthalmopathy, the cause is usually clear. These patients are not considered in this study.


Other causes of monocular elevation limitation include true elevator muscle palsy (superior rectus or superior rectus and inferior oblique), a supranuclear etiology, and various types of restrictive conditions (e.g., congenital inferior rectus fibrosis, secondary contracture of the inferior rectus). Vertical saccadic velocity studies and the clinical findings were used to differentiate among these various causes of "double elevator palsy." Slow upward saccades were thought to indicate true elevator weakness. Rapid upward saccades in the absence of a hypotropia in primary gaze indicate inferior restriction. Rapid upward saccades in the presence of a hypotropia in primary position may indicate a supranuclear cause of limited upgaze.