Abstract

Case report of a Third nerve palsy managed successfully by the fixation duress induce for the medial rectus , correcting the ptosis as well in case of aberrant regeneration.
A 20 year old young man presented with double vision and drooping of right upper eyelid with following RTA which he sustained 3 years ago. His droopy lid had improved but for the past one year there was no further improvement.VA was normal..Right pupil was dialted and fixed.He had ptosis and an Exotpia of 45pd BI with hypotopia of 15 pd base up in RE.Secondary deviation was more .Elevation was -3 and depression was -1.He had an inverse Duane's–ie palpebral fissure becoming larger in adduction. A pseudo Grafe sign+ .Surgery utilised the fixation duress of MR Recess -resection of MR& LR done with downward displacement in the nonparalytic LE which corrected the ptosis and eyes were orthophoric in primary position.Elevation in adduction was utilised by the fixation duress created in medial rectus.