When oculomotor nerve palsy is complete, the clinical picture is distinctive and surgically challenging: the eye is held in a fixed deviated position by unopposed lateral muscle forces, and the eyelid droops. This page outlines the specific scenario and points to the structured protocol for managing it.
Complete oculomotor nerve palsy results in a characteristic constellation of findings. When the palsy is complete, the eye is fixed in abduction, infraduction, and intorsion, and the eyelid is ptotic.
The surgical approach for this scenario involves a specialised transposition procedure targeting the lateral rectus muscle, combined with additional interventions on the oblique muscles to reduce abnormal deviation forces.
When the palsy is complete, the eye is fixed in abduction, infraduction, and intorsion, and the eyelid is ptotic.
Kaufman and later Gokyigit and colleagues split the LR along its long axis and transposed each half to the medial side of the globe (nasal transposition of the split lateral rectus muscle [NTSLR]).
Simultaneous IO myectomy and SO tenotomy can facilitate the transposition and also reduce abducting forces from oblique muscles.
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