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A 31-year-old male experienced 3 months of vertical diplopia with right hypertropia, with imaging and laboratory tests remaining unremarkable and forced duction testing negative. Examination showed right IR underaction with 30 prism diopter hypertropia in primary gaze. An 8-mm ipsilateral superior rectus recession achieved orthotropia and resolved diplopia.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/isolated-idiopathic-inferior-rectus-palsy-a-case-report-and-literature-review/460443/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/isolated-idiopathic-inferior-rectus-palsy-a-case-report-and-literature-review/460443.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was isolated idiopathic inferior rectus palsy diagnosed in this case?","Question",{"text":112,"@type":113},"The workup found no identifiable secondary cause, with unremarkable imaging and laboratory testing, and forced duction testing negative. The persistent symptoms without another explanation supported an idiopathic diagnosis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What clinical findings were observed at presentation?",{"text":117,"@type":113},"The patient had 3 months of vertical diplopia and right hypertropia, including right IR underaction with 30 prism diopter hypertropia in primary gaze. No subjective or objective torsion was noted and anterior/posterior segment exams were unremarkable.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment was performed and what was the outcome?",{"text":121,"@type":113},"The patient underwent an 8-mm ipsilateral superior rectus recession under general anesthesia. Postoperatively, orthotropia was achieved with resolution of diplopia, and follow-ups showed maintained satisfaction despite a small residual exotropia.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},460443,1790812321,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Case Reports in Ophthalmology  \nErratum  \nMarch 6, 2026. DOI: 10.1159/000550782  \nCase Rep Ophthalmol 2026;17:32–37  \n\n| DOI: 10. 1159/000549864\u003Cbr>Received: July 19, 2025\u003Cbr>Accepted: November 24, 2025\u003Cbr>Published online: December 1, 2025 | © 2025 The Author(s) .\u003Cbr>Published by S. Karger AG, Basel [www.karger.com/cop](www.karger.com/cop) |\n| --- | --- |\n\nThis article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([https://karger.com/Services/OpenAccessLicense](https://karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission.  \nCase Report  \nIsolated Idiopathic Inferior Rectus Palsy: A Case Report and Literature Review  \nManal Alwazae Fawziah Alhaimi  \nPediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia  \nKeywords  \nIdiopathic cases · Inferior rectus palsy · Vertical diplopia · Strabismus surgery  \nAbstract  \nIntroduction: The aims of the study were to report a rare case of isolated idiopathic inferior rectus (IR) palsy in a young adult and discuss its clinical features, diagnostic workup, and surgical management. Case Presentation: A 31-year-old male presented with a 3-month history of vertical diplopia and right hypertropia. Comprehensive ophthalmic and systemic evaluations, including imaging and laboratory tests, were conducted. Examinations revealed right IR underaction with a 30 prism diopter hypertropia in primary gaze. Forced duction testing was negative. Imaging and laboratory investigations were unremarkable. The patient underwent an 8-mm ipsilateral superior rectus (SR) recession. Postoperatively, orthotropia was achieved with resolution of diplopia. Conclusions: Isolated idiopathic IR palsy is exceedingly rare. Thorough evaluation is essential to exclude secondary causes. Ipsilateral SR recession can provide excellent functional and cosmetic outcomes in patients with persistent hypertropia and diplopia.  \n© 2025 The Author(s) .  \nPublished by S. KargerAG, Basel  \nIntroduction  \nIsolated inferior rectus (IR) palsy is an uncommon ocular motility disorder characterized by vertical diplopia and hypertropia due to underaction of the IR muscle [1–3] . Etiologies include trauma, vascular events, inflammatory conditions, and neoplasms. Idiopathic cases, where no identifiable cause is found, are exceedingly rare and pose diagnostic challenges [4, 5] .  \nCorrespondence to:  \nFawziah Alhaimi, fhaimi  [kkesh.med.sa](kkesh.med.sa)  \nCase Reports in Ophthalmology  \nCase Rep Ophthalmol 2026;17:32–37 33  \n\n| DOI: 10. 1159/000549864 | © 2025 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cop](www.karger.com/cop) |\n| --- | --- |\n\nAlwazae and Alhaimi: Isolated Idiopathic Inferior Rectus Palsy  \nManagement strategies vary based on the underlying cause and severity of symptoms. While some cases resolve spontaneously, others require surgical intervention [6–9] . This report presents a case of isolated idiopathic IR palsy in a young adult managed successfully with ipsilateral superior rectus (SR) recession.  \nCase Report  \nA 31-year-old male presented to the Pediatric Ophthalmology and Strabismus Clinic at King Khaled Eye Specialist Hospital with a 3-month history of vertical diplopia, exacerbated on right gaze. He denied any history of trauma, systemic illness, or prior surgeries. Ophthalmic examination revealed best-corrected visual acuity: 20/20 in both eyes; intraocular pressure: within normal limits in both eyes; pupils: equal, round, reactive to light, no relative afferent pupillary defect; extraocular movements: full ductions and versions; on cover/uncover test, there is right hypertropia 30 prism diopter (PD) and flick exotropia. Three-step test revealed 2 PD exotropia and 30 PD right hypertropia in primary gaze (step 1), with worsening of right hypertropia on right gaze 30 PD vs. 14 PD on left gaze (step 2), and right hypertropia on left head ","cbCaibTtXpXwpXgY","https://ap.wps.com/l/cbCaibTtXpXwpXgY","pdf",2297159,"English","# Abstract\n## Introduction\n## Case Report\n## Discussion","[{\"question\":\"Why was isolated idiopathic inferior rectus palsy diagnosed in this case?\",\"answer\":\"The workup found no identifiable secondary cause, with unremarkable imaging and laboratory testing, and forced duction testing negative. The persistent symptoms without another explanation supported an idiopathic diagnosis.\"},{\"question\":\"What clinical findings were observed at presentation?\",\"answer\":\"The patient had 3 months of vertical diplopia and right hypertropia, including right IR underaction with 30 prism diopter hypertropia in primary gaze. No subjective or objective torsion was noted and anterior/posterior segment exams were unremarkable.\"},{\"question\":\"What treatment was performed and what was the outcome?\",\"answer\":\"The patient underwent an 8-mm ipsilateral superior rectus recession under general anesthesia. Postoperatively, orthotropia was achieved with resolution of diplopia, and follow-ups showed maintained satisfaction despite a small residual exotropia.\"}]","Isolated Idiopathic Inferior Rectus Palsy - A Case Report and Literature Review | PDF",1790758486,15]