CONGENITAL OCULOMOTOR PALSY - ASSOCIATED NEUROLOGICAL AND OPHTHALMOLOGICAL FINDINGS

Congenital fourth and sixth nerve palsies are rarely associated with o ther evidence of neurological abnormality, but there have been conflic ting reports in the literature on the associations of congenital third nerve palsy, In order to clarify the situation we report a series of 14 consecutive cases presenting to a paediatric tertiary referral serv ice over the last 12 years. In this series of children, 5 had associat ed neurological abnormalities, lending support to the view that congen ital third nerve palsy is commonly a manifestation of widespread neuro logical damage, We also describe for the first time a phenomenon of di gital lid elevation to allow fixation with the affected eye, Two child ren demonstrated this phenomenon and in each case the accompanying neu rological defect was profound. The frequency and severity of associate d deficits is analysed, and the mechanism of fixation with the affecte d eye is discussed.