Elevator Palsy (eye disorder)

[CatrTim]

Hi guys,
Aussie mum here!
Mt little one 8 months has been recently diagnosed with an eye disorder called elevator palsy. The opthamologist didn’t explain the cause of it and treatment of this. I’m looking for more information from anyone!! Ie. causes, if there are any risks of further developmental disorders and who I should speak to? Paediatrician or neurologist?
the opthamologist was pretty dismissive and didnt feel it was severe.
he had delayed visual development and eye contact he had delayed social/pragmatic and language skills but appears to have caught up now but not sure what the long term impacts could be!
MIA

Is it an elevator palsy of the lid muscle or eye muscle?

@theeyeofdoe the eye muscle I assume.
the eye deviates out and then back in when attempting to look up.

Eyes both look straight at rest… if that makes sense…

That's good.

The most likely cause is something we call here - Brown's syndrome (so an inability to move the affected eye upwards, especially when it's looking towards the nose.)

it's usually due to a congenital problem with the sheath around the muscle, making it too tight, so it can't elongate when the eye wants to move up. However, that particular muscle is much longer than the others and it can also sometimes get damaged, for example by a forceps delivery.

If the eyes look straight usually, there is usually no treatment needed. Kids learn to move their head a bit more and as they grow, it becomes less of an issue as the look up less often!

I assume that the ophthalmologist looked at the other structures of the eye and didn't find anything? If that's the case, congenital Brown's syndrome is not usually associated with any developmental orders.

@theeyeofdoe Wow thank you so much for providing insight that the ophthalmologist did not. I am not really sure what testing was done as he is only 8 months old. He really only seemed to use a red light during a test. Otherwise nothing else. What sort of testing should else be done? If it is not Brown's syndrome what else could be the cause or what should I be asking the paediatrician for? He had an MRIB but awaiting the report.

Thank you so much :)

@theeyeofdoe The doctor states that because the eyes are straight there are no refractory concerns but I wasnt sure if that would be the case.

It's actually easier than it sounds, but he'll have probably used a torch on his head and a lens to look through the pupil into the back of your son's eye.
If everything looks normal - which it probably did or he would have mentioned it, then it's unlikely to be associated with another ocular condition.

There are other muscles in the eye which help to elevate it, so it could be another type of muscle palsy. But generally again that would be caused by a congentially defective muscle or birth trauma and it much more unlikely.

Possibly...did he do a quick prescription check?
Babies prescriptions are a bit all over the place at that age.

Oh I reckon when you get the report from the ophthalmologist it will be more explanatory. Brown's syndrome is a palsy of the superior oblique muscle.

@theeyeofdoe He held a torch and put a little magnifying glass in between my son's eye and the torch. I have received the report which does not indicate a cause or about refractory. Diagnosis " likely Evaluator palsy Right eye with divergence on attempted upgaze > returns rapidly to binocular vision".
My son also has his right eye pupil smaller than the left. "Physiological anisocoria with ?? superior iris absence of full development" and im not sure that impacts.

I often find that my son sort of "spaces out" when looking far away. But he didn't seem concerned.

His recommendation was review in a years time.

Overall the opthamologist was not concerned but I don't know if I should push for more investigations. He felt that my son was too young for any further testing.

@theeyeofdoe
if it isn’t elevator palsy… would there be any developmental conditions it’s associated with?

@theeyeofdoe
recieved the mri brain report that says:
”Optic nerve tortuosity bilaterally without other features to suggest IIH OR NF1”

@theeyeofdoe rwport also says nerve sheath prominence

Elevator palsy is just a description of what it is, so your son will have an elevator palsy, I just don't know for certain exactly which muscle is palsied (but it's most likely to be a Brown's syndrome).

Around 50% of children with a SEN also have an eye problem, but the converse isn't true, so most children with an eye problem don't have an SEN.

If you feel like everything is fine developmentally at the moment, then I wouldn't do anything else at the moment. Keep on eye on everything and if you're worried about anything, then see a paediatrician or another ophthalmologist.