Abstract

Monocular elevation deficit(MED) presents with limitation of elevation of the globe, more prominent in abduction. It may be associated with ptosis with or without Marcus-Gunn jaw winking phenomenon. We would like to present a case of a young female who presented to our center with MED in the left eye with exotropia and ptosis with Marcus-Gunn jaw winking. Bell’s was good, indicating a supranuclear etiology and FDT was negative for IR. Conventionally, such cases of MED with exotropia are managed in two stages/bilateral surgery: superior transposition of horizontal recti in hypotropic eye and subsequent recession-resection in other eye. However, we managed our case in single stage with superior transposition of the superior half and appropriate recession-resection of the inferior half of horizontal recti (unilateral). Postoperatively, the patient was orthotropic. Ptosis correction was done later with LPS disinsertion with excision and frontalis sling surgery.