E Khawam1, N Ghazi, H Salti. 1. Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
Abstract
BACKGROUND AND PURPOSE: To further describe the Superior Rectus Overaction/Contracture Syndrome (SRSy) first described by Jampolsky in 1964. METHODS OF STUDY: Twenty-five patients demonstrating findings characteristic of an isolated SRSy of various etiologies, but unrelated to superior oblique palsy or dissociated vertical deviation DVD, are reported. Eleven patients had surgery, consisting of superior rectus (SR) recession in ten patients and a Knapp procedure to the fellow eye (with presumed diagnosis of double elevator palsy) in one patient. RESULTS: Of the 10 patients who had SR recession of the affected eye, 9 were satisfactorily alleviated of their vertical deviation with elimination of the forced tilt difference, whereas one patient developed the SRSy in the fellow eye soon after surgery. The patient who had the Knapp procedure to the fellow eye showed, one week postoperatively, full sursumduction of that eye with significant bilateral DVD. CONCLUSION: SRSy is a common syndrome of several various etiologies. Not infrequently, whether or not associated with DVD, it may masquerade as weakness of the contralateral inferior oblique and/or superior rectus muscles. The treatment of choice is weakening of the overacting contracted SR muscle.
BACKGROUND AND PURPOSE: To further describe the Superior Rectus Overaction/Contracture Syndrome (SRSy) first described by Jampolsky in 1964. METHODS OF STUDY: Twenty-five patients demonstrating findings characteristic of an isolated SRSy of various etiologies, but unrelated to superior oblique palsy or dissociated vertical deviation DVD, are reported. Eleven patients had surgery, consisting of superior rectus (SR) recession in ten patients and a Knapp procedure to the fellow eye (with presumed diagnosis of double elevator palsy) in one patient. RESULTS: Of the 10 patients who had SR recession of the affected eye, 9 were satisfactorily alleviated of their vertical deviation with elimination of the forced tilt difference, whereas one patient developed the SRSy in the fellow eye soon after surgery. The patient who had the Knapp procedure to the fellow eye showed, one week postoperatively, full sursumduction of that eye with significant bilateral DVD. CONCLUSION: SRSy is a common syndrome of several various etiologies. Not infrequently, whether or not associated with DVD, it may masquerade as weakness of the contralateral inferior oblique and/or superior rectus muscles. The treatment of choice is weakening of the overacting contracted SR muscle.