Abstract

Synergistic divergence (SD) is a rare congenital cranial dysinnervation disorder (CCDD), characterized by the inability of the affected eye to adduct and a paradoxical abduction on attempted adduction and convergence. This strange phenomenon can be attributed to the cross-innervation between the two lateral recti (LR), or the congenital denervation of the medial rectus (MR) with aberrant innervation of LR by the oculomotor nerve. The management remains a formidable challenge. This video demonstrates a case of synergistic divergence with tight LR on FDT that was well- managed with LR periosteal globe anchor. Satisfactory results are achievable in straight ahead gaze in SD. But thorough patient counselling with realistic expectations should be set.