title: Results following treatment of third cranial nerve palsy in children.
abstract: OBJECTIVE
  To investigate the etiology, sensory, motor, and cosmetic results of treatment for oculomotor (CNIII) palsy in children.
  
  
  METHODS
  We conducted a retrospective review of the clinical records of children with a diagnosis of CNIII palsy who were followed up in our practice between 1981 and 1996.
  
  
  RESULTS
  During the 15-year period, 49 children with 53 affected eyes were followed for a mean of 5.5 years. CNIII palsy was congenital in one third of cases and secondary to postnatal trauma in another third. Thirty-three of the eyes were affected before visual maturation (age 8 years) and 27 eyes developed amblyopia. None of the 6 eyes with amblyopia in which visual acuity could be quantitated had measurable improvement of Snellen acuity after treatment. Overall, visual acuity was between 6/5 and 6/12 at the last follow-up visit in 56% of affected eyes. Ocular alignment was greatly improved after recess-resect procedures on the horizontal rectus muscles, but binocular function was difficult to preserve or restore. Blepharoptosis improved after levator palpebrae muscle resection or eyelid suspension procedures.
  
  
  CONCLUSIONS
  CNIII palsy may undergo partial resolution in children, but surgical treatment is frequently necessary. Although surgery can result in cosmetically acceptable alignment of the eyes, it rarely results in restoration or achievement of binocular function. Multiple procedures are often necessary to maintain good ocular alignment. Several surgical procedures may be needed to correct related blepharoptosis and maintain an acceptable eyelid position. Treatment of amblyopia is only effective in maintaining the level of visual acuity present at the onset of the CNIII palsy, and improvement in acuity is difficult to achieve.
authors.affiliation: Department of Ophthalmology, University of Pittsburgh School of Medicine, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Schumacher-Feero
authors.forename: K W
authors.initials: KW
authors.lastname: Yoo
authors.forename: F M
authors.initials: FM
authors.lastname: Solari
authors.forename: A W
authors.initials: AW
authors.lastname: Biglan
mesh_terms: D000293:Adolescent; D000550:Amblyopia / Q000209:etiology; D001763:Blepharoptosis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009416:Nerve Regeneration / Q000502:physiology; D015840:Oculomotor Nerve Diseases / Q000150:complications / Q000151:congenital / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013285:Strabismus / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D014947:Wounds and Injuries / Q000150:complications