Surgical treatment of upgaze palsy in Parinaud's syndrome.
BACKGROUND
Upgaze paralysis due to supranuclear defects can cause significant visual symptoms. There are only a few reports on the treatment of this problem in the literature. Patients with Parinaud's syndrome may also have retraction nystagmus and convergence on attempted upgaze that further complicates the treatment.


METHODS
We performed a retrospective review of 48 patients with Parinaud's syndrome. Eleven patients were not able to elevate to the primary position and underwent surgery for the upgaze defect. Surgical treatments included transpositions in 2 patients, inferior rectus recessions in 8, which was combined with a superior rectus resection in one.


RESULTS
Preoperative duction measurements demonstrated an average limitation on upgaze to -19 degrees (-10 to -30) below midline with zero representing midline. Postoperative measurements showed marked improvement to +19 degrees above midline (15 to 30). Inferior rectus recessions were as effective as transpositions in restoring function. In addition, there was a marked reduction in the retraction nystagmus and upgaze convergence as well.


CONCLUSIONS
Visually significant upgaze limitation can be relieved with bilateral inferior rectus recessions in Parinaud's syndrome. Retraction nystagmus and convergence movements are also markedly improved.
Buckley
Edward G
EG
Pediatric Department, Duke University Eye Center, Durham, NC 27710, USA. buckl002@mc.duke.edu
Holgado
Sandra
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003290:Convergence, Ocular; D005133:Eye Movements; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000601:surgery*; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013709:Tendon Transfer