Surgery for third nerve palsy
Reviewed by Fiona Rowe

The authors aimed to evaluate the results of a modified surgical method in patients with chronic total third nerve palsy: superior and inferior halves of the split lateral rectus muscle were passed under the superior and inferior rectus muscles and attached near the medial rectus insertion. The study included eight eyes of six patients with a mean age of 21.8 years ±12.1; two females and four males. Each case was caused by trauma. Follow-up ranged from six to 24 months. Preoperative mean horizontal angle was 74.1PD ±10.2 (range 60-90) reducing to 10.8PD ±6.6 (range 10 eso to 20 exo) postoperatively. At two months follow-up, four had stable horizontal deviation <10PD. One patient had 25PD and one had 30PD undercorrection and required additional medial rectus resection. One patient had persistent diplopia in primary position. The authors conclude that this is a useful additional procedure to consider for these cases of third nerve palsy. 

A new surgical treatment option for chronic total oculomotor nerve palsy: a modified technique for medial transposition of split lateral rectus muscle.
Erbagci I, Öner V, Coskun E, Okumus S.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2016;53(3):150-4.