Double elevator palsyの1例

A case of double elevator palsy

　著明な眼瞼下垂を伴ったdouble elevator palsyの中年症例を経験した。症例は57歳の男性で，幼少時からの左眼瞼下垂を主訴に受診した。第一眼位では，右眼固視で15度内斜視，26度左下斜視を呈し，向き眼位で程度に差のない左眼上転障害を認めた。Bell現象は陽性で，挙筋機能は比較的良好であった。本症例に水平筋上方移動術および下直筋後転術と上眼瞼挙筋短縮術を施行し，術後11度内斜視，10度下斜視となり，眼瞼下垂も改善した。中高年の眼瞼下垂をみた場合も，本症例を念頭にいれる必要がある。

A 57-year-old male presented with left blepharoptosis since childhood. The left eye showed 15 degrees of esotropia, 26 degrees of hypotropia and up-gaze disturbance. Bell's phenomenon was positive. The left levator functions were relatively fair. He was diagnosed as double elevator palsy in the left eye. The affected eye was treated by vertical transposition of horizontal rectus muscles and, later, by recession of the inferior rectus and resection of elevator muscles. The outcome was favorable with 11 degrees of esotropia and 10 degrees of hypotropia. This case illustrates that double elevator palsy may be a cause of lid ptosis even in elderly persons.