Delhi Journal of Ophthalmology

Deviant Behaviour in Third nerve Palsy

Savleen Kaur, Shagun Korla, Jaspreet Sukhija 
Post Graduate Institute of Medical Education and Research, Chandigarh, India

Corresponding Author:

Jaspreet Sukhija, Additional Professor
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
E mail: jaspreetsukhija@rediffmail.com

Received: 04-MAY-2020

Accepted: 11-MAY-2020

Published Online: 20-DEC-2020

DOI:http://dx.doi.org/10.7869/djo.607

Abstract
29-year male presented with the complaints of diplopia for 4 years following a road traffic accident 5 years ago and drooping of left eye. A diagnosis of aberrant regeneration of third nerve was made. MRI revealed temporal lobe contusion. Aberrant regeneration may be a sign of underlying cavernous sinus tumour or aneurysm. Patient was stable at a follow up of 8 months and was advised surgery.

Keywords :Third nerve paralysis, aberrant regeneration, oculomotor palsy

29-year male presented with the complaints of diplopia for 4 years following a road traffic accident and drooping of left eye. On examination best corrected visual acuity was 20/20 OU with left mild ptosis and an exotropia of 25 prism diopters in primary gaze. There was limitation of elevation, depression and adduction of the left eye (figure). Marked lid retraction was observed on looking down (pseudo-Von Graefe’s phenomenon, white arrow)and adduction (lid-gaze dyskinesis, black arrow). 
A diagnosis of aberrant regeneration of third nerve was made. MRI revealed temporal lobe contusion. Aberrant regeneration should be kept in mind as a possible late manifestation of recovering third nerve palsy.1,2 It may be a sign of underlying cavernous sinus tumour or aneurysm.3,4 Surgery on horizontal muscles of the non-involved eye improves the eyelid position.5 Patient was stable at a follow up of 8 months and was advised surgery. 


Figures 1:  29-year male highlighting limitation of elevation, depression and adduction of the left eye with mild ptosis. Marked lid retraction on looking down (white arrow) and adduction (black arrow).

References
  1. Sibony PA, Lessell S, Gittinger JW Jr: Acquired oculomotor synkinesis. Surv Ophthalmol 28:382–390, 1984. 
  2. Weber ED, Newman SA. Aberrantregenerationoftheoculomotor nerve: implicationsforneurosurgeons. Neurosurg Focus. 2007; 23:E14.
  3. Schatz NJ, Savino PJ, Corbett JJ: Primary aberrant oculomotor regeneration. A sign of intracavernous meningioma. Arch Neurol 34:29–32, 1977.
  4. Slavin, ML, Einberg KR: Abduction defect associated with aberrant regeneration of the oculomotor nerve after intracranial aneurysm. Am J Ophthal 121:580–582, 1996.
  5. O'Donnell FE, Del Monte M, Guyton DL. Simultaneous correction of blepharoptosis and exotropia in aberrant regeneration of the oculomotor nerve by strabismus surgery: a new, simplified ptosis correction for selected cases. Ophthalmic Surg. 1980 Oct;11(10):695-7.

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Kaur S, Korla S, Sukhija JDeviant Behaviour in Third nerve Palsy.DJO 2020;31:105-106

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Kaur S, Korla S, Sukhija JDeviant Behaviour in Third nerve Palsy.DJO [serial online] 2020[cited 2021 Jan 26];31:105-106. Available from: http://www.djo.org.in/articles/31/2/Deviant-Behaviour-in-Third-nerve-Palsy.html