A 3-year-old child with a history of congenital esotropia underwent bilateral medial rectus recession at 12 months. Two years post-surgery, a dissociated vertical deviation (DVD) is noted. Which finding is characteristic of DVD?
- A The eye shows limitation of elevation in adduction
- B The eye elevates, extorts, and abducts when covered or during visual inattention ✓
- C There is associated convergence and miosis on attempted adduction
- D The eye shows a rapid downward beating nystagmus
Correct answer: B. The eye elevates, extorts, and abducts when covered or during visual inattention
Explanation
DVD is characterized by slow, involuntary upward drifting (elevation), extorsion, and abduction of the non-fixating eye, typically emerging 1-3 years after surgery for infantile esotropia. It is latent and appears with occlusion or visual inattention. Limitation of elevation in adduction is Brown syndrome. Convergence and miosis on adduction is Duane retraction syndrome. Downbeat nystagmus suggests cervicomedullary pathology.
Reference: Pediatric Ophthalmology and Strabismus, AAO BCSC, 2023-2024 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.