Originally submitted: 2/23/09; Accepted: 8/4/09; Posted online: 2/23/10
Aberrant innervation involving oculomotor nerve without evidence of antecedent oculomotor nerve palsy is rare. Three patients with unilateral eyelid retraction on infraduction without a history of previous oculomotor palsy were examined. Unilateral eyelid retraction on attempted down gaze was demonstrated in all cases and all presented with ipsilateral inferior oblique overaction to a greater or lesser degree. Ipsilateral ptosis of the upper eyelids was observed in primary gaze in two cases. There were no abnormal findings in biomicroscopic and funduscopic examinations. Pupillary examinations were also unremarkable. After repair of ptosis, the upper eyelid retraction remained and became increased on down gaze. Surgery for repair of ipsilateral ptosis in congenital levator-inferior rectus synkinesis should be performed cautiously because it may aggravate the eyelid retraction on down gaze.
doi: 10.3928/01913913-20100218-07
