Abstract
INTRODUCTION AND CLINICAL IMPORTANCE: To present a case of traumatic third cranial nerve palsy and discuss the management challenges associated with this condition. CASE PRESENTATION: A 27-year-old male patient was referred to our hospital following a road traffic accident that resulted in multiple injuries, including traumatic brain injury, orbital injury. The patient presented with left complete upper lid ptosis, a fixed dilated pupil, and restricted extraocular muscle movements in the left eye except abduction with large exotropia >90 PD and hypotropia 25 PD diagnosed as left oculomotor nerve palsy. Imaging studies confirmed the presence of multiple orbital fractures. CLINICAL DISCUSSION: Oculomotor nerve palsy is a common and significant clinical finding, accounting for 30 % of all cranial nerve palsies. Third nerve palsy presents the greatest challenge, as it affects four of the six extraocular muscles, necessitating a different treatment approach. Managing patients with this condition is challenging, as the outcomes of various surgical techniques have generally been viewed as unsatisfactory. The primary goal of surgery is to achieve good ocular alignment in the primary position, but it is rarely effective in restoring measurable binocular function. CONCLUSION: This case report highlights the complex nature of managing traumatic third cranial nerve palsy, which requires a comprehensive approach to address the patient's visual and functional impairments. Further research and advancements in surgical techniques are needed to improve outcomes for patients with this condition.