title: Periosteal fixation in third-nerve palsy.
abstract: OBJECTIVE
  We present a new technique of anchoring the eyeball to the nasal periosteum using a nonabsorbable suture in acquired isolated third-nerve paresis.
  
  
  METHODS
  This was a case series of 4 consecutive adult subjects with isolated third-nerve paresis. After a 12-mm lateral rectus muscle recession in all 4 subjects, we passed 5-O double-armed polyester (NW683 Ethibond; Ethicon, Division of Johnson and Johnson Ltd., Aurangabad, India) on spatulated needles through the periosteum overlying the anterior lacrimal crest (exposed as in a Dacryocystorhinostomy procedure) at its superior part. The needles were brought anterior to the medial rectus muscle insertion and tightened enough to align the eye in 8-10 prism diopters adducted position.
  
  
  RESULTS
  Ocular alignment in the primary gaze was satisfactory at 6-12 months of follow up.
  
  
  CONCLUSIONS
  The use of a nonabsorbable polyester suture to anchor the globe to the nasal periosteum is an additional technique that holds promise to align the eyes in the primary gaze.
authors.affiliation: Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. drpsharma57@yahoo.com
authors.forename: Pradeep
authors.initials: P
authors.lastname: Sharma
authors.forename: Madhurjya
authors.initials: M
authors.lastname: Gogoi
authors.forename: Sachin
authors.initials: S
authors.lastname: Kedar
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhola
mesh_terms: D000328:Adult; D005133:Eye Movements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D015840:Oculomotor Nerve Diseases / Q000150:complications / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D010521:Periosteum / Q000601:surgery*; D013285:Strabismus / Q000209:etiology / Q000601:surgery*; D013536:Suture Techniques