Third cranial nerve palsy in children

PURPOSE: To report the causes and the sensory, motor, and cosmetic results after treatment for oculomotor (third cranial nerve) palsy in children, METHODS: Review of the clinical records of children with a diagnosis of thi rd cranial nerve palsy followed up in a university-based pediatric ophthalm ology practice between 1981 and 1996. RESULTS: Forty-nine children with 53 affected eyes were followed up for a m ean of 5.5 years. Third cranial nerve palsy was partial in 31 children (32 eyes) and complete in 18 children (21 eyes). The palsy was congenital in 20 eyes and caused by postnatal trauma in 17 eyes. Seventeen eyes had aberran t regeneration and four eyes with partial third cranial nerve palsy had spo ntaneous resolution. Thirty-six children (38 eyes) were affected before vis ual maturation (age 8 years), and 25 (27 eyes) had amblyopia, Of the five a mblyopic eyes with quantifiable visual acuity, none had measurable improvem ent of Snellen visual acuity during the follow-up period. Overall, visual a cuity was between 6/5 and 6/12 at the last follow-up visit in 31 eyes (58%) . Ocular alignment was greatly improved after strabismus procedures, with a mean of 1.5 procedures for patients with partial third cranial nerve palsy and 2.3 procedures for those with complete palsy. Binocular function was d ifficult to preserve or restore but was achieved for some patients with par tial third cranial nerve palsy. CONCLUSIONS: Surgical treatment of third cranial nerve palsy is frequently necessary, especially in cases of complete palsy. Multiple strabismus proce dures are often needed to maintain good ocular alignment. Surgery can resul t in cosmetically acceptable alignment, of the eyes, but it rarely results in restoration or achievement of measurable binocular function. Treatment o f amblyopia is effective in maintaining the level of:visual acuity present at the onset of the third cranial nerve palsy, but improvement: in visual a cuity is difficult to achieve. (C) 1999 by Elsevier Science Inc. All rights reserved.