ABSTRACT
ABSTRACT: Introduction: Mobius syndrome is a congenital disorder of facial diplegia associated with bilateral lateral rectus paralysis. Clinically it is characterized by a total absence of facial expression and severe esotropia with or without limb abnormalities. The purpose is to report congenital epiblepharon as a new clinical manifestation of Mobius syndrome and present the outcome related to motor alignment after hang back medial rectus recession. Methods: Case report. Results: A 6-month old male infant was referred for ophthalmic evaluation by Pediatrician. The child was a product of a term, uncomplicated pregnancy with a birth weight of 3500 gm. There was no history of alcohol, drug ingestion or any medications taken during pregnancy. Pediatrician evaluation records showed congenital talipes eqinovarus both foot with mild cerebral atrophy in CT scan of brain. Ophthalmic examination showed expression less face, loss of nasolabial folds, marked epicanthal folds, epiblepharon of both lower lids with mild trichiatic lashes and lagophthalmos. No corneal problems were seen. Ocular motility showed large esotropia of 50 to 60 PD by krimsky test with marked limitation of abduction in both eyes (not moving beyond midline). A forced duction test under anaesthesia revealed restriction mild in abduction. A bilateral hang back medial rectus recession of 6.5 mm from insertion was done. One week after surgery the child was orthotropic with stable alignment maintained at 26 months follow-up. Conclusions: This case highlights the association of epiblepharon with Mobius syndrome which to our knowledge is previously unrecognized. Good cosmetic and motor alignment was achieved with hang back recession of medial rectus muscle.
