Ocular fixation to nasal periosteum with a superior oblique tendon in patients with third nerve palsy

Purpose: To report a new surgical approach that uses ocular fixation to the nasal periosteum with superior oblique tendon for patients with complete t hird nerve palsy. Methods: Prospective study of 15 patients with complete third nerve palsy w ho under-went surgery using a superior oblique tenectomy and ocular fixatio n to the nasal periosteum with the superior oblique tendon fragment. Results: Eleven (73%) patients achieved good ocular alignment, 1 (7%) patie nt had a cosmetically acceptable result, and 3 (20%) patients had a cosmeti cally unacceptable result. Five (30%) patients had preoperative diplopia; a ll achieved resolution of their double vision in the primary position of ga ze after surgery. Two patients without preoperative diplopia did not achiev e good alignment and had diplopia postoperatively. Follow-up ranged from 8- 41 months (mean: 19 months). No operative complications occurred. Conclusion: Ocular fixation to the nasal periosteum with superior oblique t endon is a safe, effective, and technically undemanding option for the surg ical management of patients with complete third nerve palsy.