Abstract
Congenital fourth and sixth nerve palsies are rarely associated with other evidence of neurological abnormality, but there have been conflicting reports in the literature on the associations of congenital third nerve palsy. In order to clarify the situation we report a series of 14 consecutive cases presenting to a paediatric tertiary referral service over the last 12 years. In this series of children, 5 had associated neurological abnormalities, lending support to the view that congenital third nerve palsy is commonly a manifestation of widespread neurological damage. We also describe for the first time a phenomenon of digital lid elevation to allow fixation with the affected eye. Two children demonstrated this phenomenon and in each case the accompanying neurological defect was profound. The frequency and severity of associated deficits is analysed, and the mechanism of fixation with the affected eye is discussed.
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Miller NR . Solitary oculomotor nerve palsy in childhood. Am J Ophthalmol 1977; 83: 106–11.
Balkan R, Hoyt CS . Associated neurologic abnormalities in congenital third nerve palsies. Am J Ophthalmol 1984; 97: 315–9.
Hamed LM . Associated neurologic and ophthalmic findings in congenital oculomotor nerve palsy. Ophthalmology 1991; 98: 708–14.
Ing EB, Sullivan TJ, Clarke MP, Buncic JR . Oculomotor nerve palsies in children. J Pediatr Ophthalmol Strabismus 1992; 29: 331–6.
White L, Mumma JV, Tomasovic JJ . Congenital oculomotor nerve palsy, cerebellar hypoplasia, and facial capillary haemangioma. Am J Ophthalmol 1992; 113: 497–500.
Good WV, Barkovich AJ, Nickel BL, Hoyt CS . Bilateral congenital oculomotor nerve palsy in a child with brain anomalies. Am J Ophthalmol 1991; 111: 555–8.
Kazarin EL, Flynn JT . Congenital third nerve palsy with amblyopia of the contralateral eye. J Pediatr Ophthalmol Strabismus 1978; 15: 366–7.
Victor DI . The diagnosis of congenital unilateral third nerve palsy. Brain 1976; 99: 711–8.
Harley RD . Paralytic strabismus in children: etiologic incidence and management of third, fourth, and sixth nerve palsies. Ophthalmology 1980; 87: 24–43.
Flanders M, Watters G, Draper J, O'Gorman A . Bilateral congenital third cranial nerve palsy. Can J Ophthalmol 1989; 24: 28–30.
Naylor G, Roper JP, Willshaw HE . Ophthalmic complications of amniocentesis. Eye 1990; 4: 845–9.
Lepore FE, Glaser JS . A critical appraisal of acquired oculomotor nerve synkinesis. Arch Ophthalmol 1980; 98: 2206–9.
Walsh FB . Communications. Third nerve regeneration. Br J Ophthalmol 1957; 41: 577–98.
Keith CG . Congenital ocular palsy. Br J Ophthalmol 1972; 56: 356–61.
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Tsaloumas, M., Willshaw, H. Congenital oculomotor palsy: Associated neurological and ophthalmological findings. Eye 11, 500–503 (1997). https://doi.org/10.1038/eye.1997.134
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DOI: https://doi.org/10.1038/eye.1997.134