Clinical Features and Outcomes of Strabismus Treatment in Third Cranial Nerve Palsy during a 10-Year Period

Purpose: to evaluate the demographics and management outcomes of strabismus surgery in patients with third cranial nerve palsy. methods: this retrospective study includes subjects with third cranial nerve palsy. we evaluated age,sex,laterality,severity of involvement,etiology,frequency of clinical findings,and types and results of treatments. results: 52 patients including 29 male and 23 female subjects with mean age of 21.1±15.5 years were studied between january 1999 and january 2009. etiologies of third nerve palsy included congenital in 16 (30.8%),trauma in 26 (50%) and other causes in 10 (19.2%) patients. in 24 patients (46.2%),the palsy was complete. the most common type of strabismus was exotropia associated with hypotropia (40%). medical treatment was used in 25 (48%) and surgical treatment in 46 (88.4%) subjects. one time strabismus surgery was performed in 30 (65.2%),2 times in 11 (24%) and 3 times in 5 (10.8%) subjects. the most common operation was large horizontal recession and resection in 78.2% of cases. mean horizontal deviation in primary position was 66±29 prism diopters (pd) before surgery decreasing to 21±19,13±12 and 6±8 pd after first,second and third surgery,respectively. corresponding figures for mean vertical deviation were 13±15,7±12,4±6 and 1±2 pd,respectively. abnormal head posture was 10-30° in 11 (21.1%) cases before treatment which completely resolved after surgery. conclusion: surgical management of strabismus in patients with third nerve palsy is difficult and challenging,however the majority of patients achieve ideal results with appropriate and stepwise surgical plans.