A Case of Herring’s Law in a Patient with Blepharoptosis
Keywords:
blepharoptosis, Hering's law, agonists, dominant eye.Abstract
Introduction: Blepharoptosis, or palpebral ptosis, is an entity in which the upper eyelid margin is abnormally low in the primary sight position, decreasing the palpebral fissure and covering part of the eyeball. This entity may affect one or both eyes. Hering's law, or law of motor correspondence, may be present in patients operated on for unilateral blepharoptosis. Such law states that, in every binocular movement, the innervational stimulus received by the agonist muscle is equal to the one received by its partner muscle.
Objective: To determine the mechanism of presentation of Hering's law in a patient with surgically corrected unilateral upper blepharoptosis, as well as the behavior to follow in this case.
Case presentation: A 53-year-old female patient presented with visual decrease of the left eye due to drooping of the upper eyelid one year ago; it was accompanied by lacrimation, blurred vision, discrete esotropia and the presence of functional reduction of the upper visual field. The palpebral ptosis was surgically corrected, apart from the presentation of drooping upper eyelid in the adelphic eye.
Conclusions: When assessing a patient with blepharoptosis, we should not forget to determine, especially in unilateral cases and before surgery, which the directing or dominant eye is. The surgeon should explain the law of reciprocal innervation to the relatives and the patient before the surgical procedure, so that they are informed about the possible effects on the blepharoptosis eye and the conduct to follow in this entity.
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