Parry-Romberg syndrome is a progressive hemifacial atrophy with idiopathic craniofacial disorder characterised by slowly progressive atrophy of soft tissues on one side of the face. A case is presented of acquired monocular elevation deficit in a child without restrictive component. A 12-year-old presented with left hypotropia and ptosis, 20/20 visual acuities, poor Bells response, limited elevation in abduction and a 30PD hypotropia in primary gaze. Forced duction test was negative and surgery involved a Knapp procedure of the left eye with ptosis surgery six months later (frontalis suspension). Postoperatively the child was ortho in primary gaze that was maintained for five years of follow-up along with improved ptosis and Bell’s response. The diagnosis in this case was acquired paralytic strabismus and the authors suggest it was related to the Parry Romberg syndrome, perhaps through an essential neural degenerative process.