Surgical Outcome of an Isolated Inferior Rectus Muscle Palsy: A Case Report

Abstract

Introduction: Isolated inferior rectus muscle palsy is an uncommon disorder of ocular motility that produces vertical deviation and double vision. The condition most often follows orbital trauma and can resemble other vertical strabismus entities, making diagnosis challenging.

Case Presentation: A 27-year-old man presented with persistent vertical diplopia in his left eye for one year after blunt ocular trauma. Clinical findings indicated left hypertropia with limited depression, consistent with inferior rectus muscle palsy. Orbital imaging revealed no evidence of fracture or entrapment. After a year of conservative therapy without improvement, surgery was performed—consisting of a 4-mm superior rectus recession and a 4-mm inferior rectus resection on the affected eye. Postoperative recovery was excellent, with restoration of normal alignment, full ocular motility, and complete resolution of diplopia within two weeks.

Discussion: Traumatic isolated inferior rectus palsy is rare and may be mistaken for other causes of vertical misalignment. When spontaneous recovery does not occur, a balanced surgical approach involving both recession and resection provides predictable alignment and satisfactory binocular function.

Conclusion: Combined superior rectus recession and inferior rectus resection represent an effective and reliable option for achieving stable ocular alignment and eliminating diplopia in chronic traumatic inferior rectus palsy resistant to conservative treatment.