PP21 : Aberrant regeneration of third nerve with characteristic lid signs: Operating on the fellow eye

Dr.Sumita Sethi Gulati

A 16 years old female with history of head trauma 10 years back presented with complaint of deviation and aperture changes OD. Imaging of brain revealed no abnormality. BCVA OD was 1/60; there was afferent pupillary defect and anisocoria; in primary gaze there was right exotropia (50 D), hypotropia (8D) by Krimsky and mild ptosis. Supraduction was absent, infraduction was limited OD and there was characteristic elevation of right upper lid on adduction (horizontal gaze-eyelid synkinesis), retraction and elevation of upper eyelid on downgaze (pseudo- Graefe sign) and limitation of elevation and depression of the eye with occasional retraction of the globe on attempted vertical movement. Diagnosis of third nerve palsy OD with aberrant regeneration was established. In lieu of the significant lid aperture changes it was realized that surgery on the same eye might worsen the aperture changes; recession and resection of the fellow eye was undertaken with satisfactory post-operative alignment