Combined recession-resection in the management of paralytic strabismus: simplification of the complex (a case report).

Abstract

Oculomotor nerve palsy presents the greatest challenge in clinical treatment among the other cranial nerves that innervate extraocular muscle. With a complex technique of periosteal fixation using Callahan suture commonly used, a simpler and more effective technique is demanded to be proven. Here we present a case of paralytic exotropia due to oculomotor nerve palsy on a 32-year-old male along with evidence supporting our decision of surgical management. A 32-year-old male with a chief complaint of squint in both eyes was examined at an outpatient eye clinic. The patient had congenital isolated partial oculomotor nerve palsy and the examination revealed severe ptosis on both eyes with 40 prism diopter exotropia and no limitation in the forced duction test. The patient's posterior segment examination showed normal results, and a diagnosis of bilateral paralytic exotropia due to isolated partial oculomotor nerve palsy was considered. The patient underwent a 7.5 mm rectus lateral recession with a 6 mm rectus medial resection on his right eye, with a promising result after a 3-week follow-up. When treating paralytic strabismus resulting from isolated oculomotor nerve palsy, a combination of medial rectus resection and lateral rectus recession yields good results and long-term stability.