third nerve palsy; etiology and outcomes of therapy over a 10 years period

purpose: to evaluate demographics and therapeutic outcomes of patients with third nerve palsy who had been treated between 1999 to 2009 at labbafinejad medical center. methods: in this retrospective study, we evaluated 52 patients with third nerve palsy who had been referred to labbafinejad medical center over a ten-year period. results: in this retrospective study, subjects who had been treated for third nerve palsy from 1999 to 2009 at labbafinejad medical center were enrolled. of 52 subjects enrolled in this study 29 (55.8%) were men and 23 (44.2%) were women. mean age was 21.1 (sd: 15.5); 25 subjects (48.1%) had third nerve palsy in their right eye and 26 subjects (50%) had it in their left eye. both eyes were involved in one subject (1.9%). etiologies of 3rd nerve palsy included congenital 16 (30.8%), trauma 26 (50%), ischemia 2 (3.8%), tumor 2 (3.8%), viral meningitis one (1.9%) and unknown causes in 5 subjects (9.6%). in 38 subjects (73.1%) the palsy was isolated but in 14 subjects (26.9%) it was associated with other cranial neuropathies or neurologic deficits. the palsy was complete in 24 patients (46.2%) and incomplete in 28 patients (53.8%). ptosis was seen in 45 subjects (86.5%). the most common type of strabismus was exotropia associated with hypotropia (40%). medical treatment was performed in 25 (48%) and surgical treatment in 46 (88.4%) subjects. one, two and three step strabismus surgery was done in 30 (65.2%), 11 (24%) and 5 (10.8%) subjects respectively. mean horizontal deviation in primary position was 66 prisms before surgery which was decreased to 21, 13 and 6 after first, second and third surgery, respectively. mean vertical deviation was 13 prisms before surgery which was decreased to 7, 4 and 1 after first, second and third surgery, respectively; 18 of 52 subjects 34.6 % underwent ptosis surgery. one, two and three step ptosis surgery was performed in 15 (83.3%), 1 (5.5%) and 2 (11%) cases respectively. mean palpebral fissure height in patients who underwent ptosis surgery was increased from 4 mm to 7mm. conclusion: in our study the first and second main causes of third nerve palsy leading to surgical intervention were trauma and congenital abnormalities, respectively. great number of patients required surgery to achieve acceptable treatment results. in conclusion, surgical management of patients with third nerve palsy is difficult and challenging but most patients achieve good results with appropriate and stepwise surgical plans.