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Antielevation Syndrome caused by Sensory Strabismus Surgery in Morning Glory Syndrome
Ann Optom Contact Lens 2020;19:110-113
Published online December 25, 2020
© 2020 The Korean Optometry & Contact Lens Study Society

Woo Jung Chae, MD, Soon Young Cho, MD

Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea
Correspondence to: Soon Young Cho, MD
Department of Ophthalmology, Dongguk University Gyeongju Hospital, #87 Dongdae-ro, Gyeongju 38067, Korea
Tel: 82-54-770-8256, Fax: 82-54-772-9618
Received August 31, 2020; Revised October 8, 2020; Accepted October 23, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: We report a case of antielevation syndrome caused by sensory strabismus surgery for the treatment of exotropia and hypertropia in morning glory syndrome.
Case summary: A 4-year-old girl visited our hospital due to outward deviation of her left eye since birth. She showed 60 prism diopters (PD) exotropia and 20 PD hypertropia of her left eye by the Krimsky test. During fundus examination, we found funnel-shaped excavation of the posterior fundus. She was diagnosed to have sensory exotropia and hypertropia associated with morning glory syndrome. The patient received lateral rectus muscle recession (9.0 mm), medial rectus muscle resection (7.0 mm) and inferior oblique anteriorization 1.0 mm posterior to the inferior rectus muscle lateral border on her left eye. One week after surgery, the patient showed orthotropia at near fixation and far fixation in the primary position, and 2 months after surgery, the patient showed 6 PD exotropia and 2 PD hypertropia at near fixation and 10 PD exotropia at far fixation of her left eye in the primary position. However, antielevation syndrome was noticed and attributed to the use of unilateral inferior oblique transposition for the correction of hypertropia.
Conclusions: The exptropia and hypertropia in morning glory syndrome was effectively treated with lateral rectus muscle recession, medial rectus muscle resection and inferior oblique muscle transposition. This case cautions meticulous care is needed to prevent antielevation syndrome when performing unilateral inferior oblique transposition.
Keywords : Morning glory syndrome; Strabismus; Surgery

December 2020, 19 (4)