8 yr old child with inability to look down referred for MRI with clinical suspicion of inferior rectus anomaly. MRI shows hypoplasia of right inferior rectus belly compared with other muscles , possible accessory extraocular muscle just above it, with absence of left inferior rectus. Case submitted by Dr MGK Murthy.
Teaching points
- All extraocular muscles have been described to be absent congenitally, with most common being inferior recti, superior recti, and superior oblique , in that order
- Presence of accessory extraocular muscles with hypoplasia /aplasia has recently been described. Associated with craniofacial dysostosis, Neurofibromatosis , though isolated cases are common
- Symptoms could be Hypertropia on the affected side, with limited depression of more affected side
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