A rare case of Moebius sequence
An 18-year-old male came to Mamata General Hospital in January 2010 with a history of restricted outward movements of the eyes, inability to form facial expressions and to completely close the left eye, along with associated limb deformities, and inability to completely close the mouth, present since childhood. He had additional complaints of watering along with burning and gritty sensation of the left eye since past 6 months for which he took an ophthalmic consultation.\nGeneral physical examination revealed both upper and lower limb deformities in the form of webbed fingers and poorly developed palms on the upper limbs and maldeveloped right lower limb [Figs. and ]. Facial examination revealed deviation of the nose to the right, thickened lower lip, and inability to fully approximate the lips even on forceful attempts []. There was no tongue atrophy.\nOn ocular examination, his best corrected visual acuity was 20/20 in both eyes with +0.50 diopter sphere (Dsph). Near vision was N/6 in both eyes. The examination of visual axes revealed the eyes to be parallel with each other. There was restricted convergence and extraocular movements were totally restricted in abduction, and dextro- and levoversions showed moderate restriction of adduction []. There was no diplopia at near or distance or any kind of nystagmus in any gaze. Lagophthalmos of the left eye and a positive Bell's phenomenon was present due to ipsilateral facial nerve palsy [] and there was loss of conjunctival luster due to exposure.\nRest of the anterior segment evaluation showed normal anterior chamber, briskly reacting pupils, and no opacities in the lens. Fundus examination also was within normal limits. Forced duction test performed was found to be negative. A magnetic resonance (MR) imaging of the pons and adjacent brainstem was also ordered which did not show any abnormality or any nuclear hypoplasia.\nThe patient was managed by prescribing lubricating eye drops four times a day, and the necessity to undergo a left-side lower lid tarsorraphy and its surgical outcome was explained to him.