Surgical Options for Eye Muscle Surgery in Third Nerve Palsy

Uni- or bilateral third nerve palsies account for about one third of cranial nerve palsies affecting ocular motility. Due to the large nuclear complex of the third nerve and due to the multiple effector muscles of the third nerve, incomplete palsies are common. When conservative treatment is insufficient and a potential remission did not occur, surgical intervention on the extraocular muscles may be indicated to reduce diplopia, establish a field of binocular single vision or relieve annoying head postures or improve the patient's appearance. Standard procedures in strabismus Surgery such as simple recessions or strengthening procedures often do not yield permanent effects under the conditions of third nerve palsies so that transposition procedures may be required. Special considerations in individual indications, e. g., concerning binocular prognosis, possible misinnervation and potential accompanying fourth nerve palsy are discussed in general and illustrated with case reports.