Abstract • We examined two sisters with lid retraction on adduction, the classic sign of levator-oculomotor synkinesis. In both women, the left eye was involved. No history of trauma or ocular surgery or complaints of diplopia were elicited, and both had good visual acuity and full ocular motility. Each exhibited 2 mm of left upper lid elevation on adduction and 4 to 6 mm of lid elevation on adduction with depression. In one of the sisters, 1 mm of ptosis was present in straight ahead gaze in the involved eye, which increased to almost 2 mm on abduction, but full levator function was observed. Four other family members in three consecutive generations were similarly affected, suggesting an autosomal-dominant mode of inheritance. To our knowledge, this type of isolated levator-oculomotor synkinesis has not been reported previously on a congenital and inherited basis. References 1. Friedenwald H: On movements of the eyelids associated with movements of the jaws and with lateral movements of the eyeballs . Johns Hopkins Hosp Bull 1896;7:134-136. 2. Walsh FB: Clinical Neuro-ophthalmology , ed 2. Baltimore, Williams & Wilkins, 1957, pp 194-203, 232. 3. Duke-Elder S, Scott GI: Neuro-ophthalmology , in Duke-Elder S (ed): System of Ophthalmology . London, Henry Kimpton, 1971, vol 12, pp 905-915. 4. Ticho U: Synkinesis of upper lid elevation occurring in horizontal eye movements . Acta Ophthalmol 1971;49:232-238.Crossref 5. Sinclair WW: Abnormal associated movements of the eyelids . Ophthalmic Res 1895;14:307-319. 6. Bender MB: The nerve supply to the orbicularis muscle and the physiology of movements of the upper eyelid . Arch Ophthalmol 1936;15:21-30.Crossref 7. Glaser JS: Congenital anomalies of innervation , in Duane TD (ed): Clinical Ophthalmology . New York, Harper & Row Publishers Inc, 1978, vol 2, pp 1-7. 8. Browning F: Associated contraction of the levators palpebrarum superiorus with the internal recti . Trans Ophthalmol Soc UK 1890;10:187-190. 9. Martyn HS: Notes on a case of anomalous innervation of the levator palpebrae superiorus (left) . Br J Ophthalmol 1919;3:310-313.Crossref 10. Phillips S: Associated movement of the upper lid with movement of the eyeball . Trans Ophthalmol Soc UK 1887;7:306-307. 11. Huber A: Electrophysiology of the retraction syndromes . Br J Ophthalmol 1974;58:293-300.Crossref 12. Hotchkiss MG, Miller NR, Clark AW, et al: Bilateral Duane's retraction syndrome: A clinical pathologic case report . Arch Ophthalmol 1980; 98:870-874.Crossref 13. Miller NR, Kiel SM, Green WR, et al: Unilateral Duane's retraction syndrome (type I) . Arch Ophthalmol 1982;100:1468-1472.Crossref 14. Sano K: Trigemino-oculomotor synkineses . Neurologica 1949;1:53-59. 15. Falls HF, Kruse WT, Cotterman CW: Three cases of Marcus Gunn phenomenon in two generations . Am J Ophthalmol 1949;32:53-59.
Archives of Ophthalmology – American Medical Association
Published: Oct 1, 1986
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