The authors present the unusual case of a 23-year-old male presenting to hospital with right eye pain, right upper eyelid ptosis, blurred vision and diplopia, developing immediately after a penetrating injury to his right upper eyelid. On assessment he was found to display an isolated traumatic oculomotor nerve palsy with pupil involvement. Direct penetrating injuries causing isolated oculomotor nerve palsies are rare, with just one previously reported case found by the authors involving a shrapnel injury. The patient was followed up for 14 months during which time he improved, with almost complete resolution of the diplopia, anisocoria and ptosis. The case reported is unique, in that the orbital penetration trauma affected no other tissue of the orbit or globe. Apart from the nerve palsy, only a small lid abrasion was discovered.

A rare case of penetrating trauma resulting in isolated third nerve palsy.
Story C, Patterson M, McWilliams W, Bray Markowitz BB.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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