Strategies for managing strabismus from oculomotor nerve palsy
Claudia Yahalom, David G. Hunter, Linda R. Dagi
Abstract
Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when treating patients with binocular diplopia.We review the reported surgical options and, through illustrative cases, provide our own perspective on managing this disorder.( J AAPOS 2023;27:3-9) O culomotor nerve palsy results in disfiguring, incomitant strabismus.When the palsy is complete, the eye is fixed in abduction, infraduction, and intorsion, and the eyelid is ptotic.With partial oculomotor nerve palsy, the involved muscles are paretic to varying degrees. 1,2The aim of strabismus surgery is to align the eyes in primary position and, when possible, restore a useful field of binocular single vision.In this workshop, we discuss surgical correction of both complete and partial oculomotor nerve palsy and review strategies for managing reoperations. Primary RepairPrimary repair addresses reduction of a large-angle exotropia and, as needed, vertical misalignment and torsional diplopia.The two most important considerations for management are, first, whether the palsy is complete or partial, and, second, whether or not the strabismus is accompanied by binocular diplopia.