Periosteal fixation in third-nerve palsy.
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.
Sharma
Pradeep
P
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. drpsharma57@yahoo.com
Gogoi
Madhurjya
M
Kedar
Sachin
S
Bhola
Rahul
R
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