Oculomotor Nerve Palsy(Third Cranial Nerve Palsy)

http://www.stritch.luc.edu/depts/ophtha/adult_strabismus/oculomotor_nerve_palsy.htm

Oculomotor nerve palsy is an eye condition resulting from damage to the third

cranial nerve or a branch thereof. As the name suggests, the oculomotor nerve

supplies the majority of the muscles controlling eye movements. In a complete

Oculomotor nerve palsy, the affected eye will normally be in a down and out position

relative to the other eye.  The affected eye will also have a ptosis, or drooping of the

eyelid, and pupil dilation.  In a partial oculomotor palsy different eye muscle groups

may be affected, thus producing different appearances of the eye and different

symptoms.  In general, the limitations of eye movements resulting from the condition

are so severe that the affected individual is unable to maintain normal alignment of

their eyes when looking straight ahead (strabismus) and, as a consequence have

double vision (diplopia).

Congenital Oculomotor Palsy

The origins of the vast majority of congenital oculomotor palsies are unknown.

There is some evidence of a familial tendency to the condition, particularly in partial

palsies involving the superior division of the nerve with an autosomal recessive

inheritance. The condition can also result from aplasia or hypoplasia of one or more of

the muscles supplied by the oculomotor nerve. It can also occur as a consequence of

severe birth trauma.

Acquired Oculomotor PalsyAcquired oculomotor palsies have a number of different causes including:

1. Vascular disorders such as diabetes, heart disease, atherosclerosis and aneurysm, particulary of the posterior communicating artery.

2. Space occupying lesions or tumors3. Inflammation and Infection4. Trauma5. Demyelinating disease (Multiple sclerosis)6. Auto-immune disorders such as AIDS or Myasthenia gravis7. Post operatively as a complication of neurosurgery.

Treatment There is no direct medical or surgical treatment that alters the course of the disease initially. Fortunately, nearly all patients undergo spontaneous remission of the palsy, usually within 6-8 weeks.

Treatment during the symptomatic interval is directed at alleviating symptoms, mainly pain and double vision (diplopia).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment of choice for the pain.  Diplopia is not a problem when ptosis occludes the involved eye.When diplopia is from a large deviation of the eyes, patching one eye is a practical short-term solution. When the degree of deviation is smaller, double vision can often be achieved using horizontal or vertical prisms.