Surgical management of large-angle incomitant strabismus in patients with oculomotor nerve palsy

Precaruncular approach for medial orbital wall periosteal anchoring of the globe in oculomotor nerve palsy

“…This intraoperative placement has been recommended by others. 9,[14][15][16] The modification in suture placement for vertical tropia as in Case 14 has also been suggested in previous articles 9,10 ; however, in our experience this was not sufficient to fully correct the vertical deviation with a single procedure. Considering that the vascular supply of the medial rectus muscle is left intact, it will be possible to perform subsequent surgery on the vertical rectus muscles if necessary to correct for any residual vertical tropia.…”

“…The procedure has the advantage of better adhesion and less chance of rejection, but it is associated with persistent congestion and swelling on the nasal conjunctiva that requires conjunctival excision and flattening of the medial canthal area. 15 Most surgeons differ in their approach to the medial orbital wall. A skin incision gives good exposure of structures at the medial canthal area; however, the chemosis and fullness of the medial canthal region persists postoperatively for months.…”

Managing the patient with oculomotor nerve palsy

“…Some flattening of the medial canthal area has been reported with this procedure [39]. Some flattening of the medial canthal area has been reported with this procedure [39].…”

“…Paralysis of the upper division of the oculomotor nerve results in ptosis due to involvement of levator palpebrae superioris and limitation of elevation due to superior rectus involvement. When hypertropia of the affected eye is the main ocular motility finding or when there is aberrant regeneration causing the eye to elevate in attempted depression, then resection and anterior transposition of the paretic inferior oblique can be beneficial [39]. Patients with isolated medial rectus muscle palsy may benefit from periosteal anchoring of the medial rectus with or without lateral rectus disinsertion [34 & ].…”

Predictive factors of surgical outcome in oculomotor nerve palsy

“…Results from the largest published series of surgery for oculomotor nerve palsy surgery are compared in Table 5. [14][15][16][17][18][19][20] In conclusion, only time from onset to surgery and amount of eye deviation are valuable in estimating the prognosis of surgery for oculomotor nerve palsy. To our knowledge, there are no previous studies on predictive factors of outcome for surgery of third cranial nerve palsy.…”