Authors:Dr. Jayesh Suresh Patil, Dr. Mangesh Dhobekar, Dr. Prasanna Aradhye, Dr. Amrita Ajani

1. Monocular elevation deficit with Pellucid Marginal
Degeneration: A case report
Authors:
− Dr Jayesh Suresh Patil
− Dr Mangesh Dhobekar
− Dr Prasanna Aradhye
− Dr Amrita Ajani
Token No. 0414

2. Introduction
Monocular elevation deficiency
inability to elevate eye in all
fields of gaze
presents with hypotropia of
affected eye which is equal
in all gazes
pseudoptosis with or without
true ptosis
Aetiology includes
supranuclear defects or
primary superior rectus
paresis or primary inferior
rectus restriction or
combination
Pellucid marginal degeneration
Peripheral corneal ectatic
disorder
Band of thinning 1–2 mm in
width, typically in the
inferior cornea,
high irregular astigmatism
Corneal topography shows
characteristic and typical
appearances.

3. Purpose:
To report and discuss a case of association between
monocular elevation deficiency(MED) and pellucid
marginal degeneration(PMD) and its management.
Association of monocular elevation deficit with
pellucid marginal degeneration is not reported before

4. History and examination
A 20 year old male came to OPD with drooping of
right upper eyelid since birth with poor vision.
Examination:
Right sided severe congenital ptosis with Marcus-
Gunn jaw winking and poor Bell's phenomenon was
noted. Right hypotropia was present which was equal
in all horizontal gazes.

5. Anterior segment and Fundus
Right Eye Left Eye
BCVA
6/45 6/6
Refraction
-1.00DS/-8.50DCX60 Plano
Lid
Severe Ptosis Normal
Conjuctiva
Clear Clear
Cornea
Clear Clear
Anterior
chamber
Quiet, well formed Quiet, well formed
Iris Pattern Normal Normal
Pupil Round regular,
brisk reaction
Round regular,
brisk reaction
Lens Clear Clear
IOP 16 mm Hg 16 mm Hg
Fundus WNL WNL

6. Squint Examination and plan
APCT/EOM
FDT Positive for Inferior rectus
FGT negative for Superior Rectus
Plan :
Stage I Inferior
rectus recession
Stage II Knapp's
procedure with
Foster
augmentation

7. Pre-op 9 gaze photos

8. Status post OD Knapp's procedure

9. Topography and pachymetry was performed pre-
operative and after 6 weeks
07-09-
2016
20-07-
2016
17-06-
2016

10. Further plan
For Ptosis with Marcus-Gunn Jaw winking
Planned for OD LPS muscle resection + Frontalis sling
procedure
For Pellucid Marginal degeneration :
To wait and watch for now. If corneal topography is
stable, Nil intervention
If Progression noted, may plan for Collagen cross-
linking or surgical inetervention

11. Discussion & Conclusion
Monocular elevation deficiency is commonly
associated with congenital ptosis, Marcus-Gunn jaw
winking phenomenon. Other ocular associations of
MED were not much reported. Here we are
presented a case of association between monocular
elevation deficit with pellucid marginal
degeneration. Further evaluation and follow up will
be required to confirm association and aetiological
correlation

12. Thank you...
Shri Ganapati Netralaya Presentation