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Principles of Surgical Management of Cranial Nerve Palsies

Correspondence: Requests for reprints should be addressed to: R. Michael Siatkowski, Dean A. McGee Eye Institute, Dept. of Ophthalmology, Univ. of Oklahoma, 608 Stanton L. Young Blvd., Okla-homa City, OK 73104. email: Rmichael-Siatkowski{at}ouhsc.edu

Background and Purpose: Cranial nerve palsies following cranial and/or ocular trauma are common. Surgical correction of these patients may be challenging and different concepts in surgical planning are required, as compared to patients with non-paretic or comitant strabismus.

Methods: Essay presentation and review of the literature.

Results: Degree of paralysis and severity of ductional deficit is the most important factor when devising a surgical plan for these cases. Efforts should be made to normalize ductions when possible by improving movement of the paretic eye. When this is not feasible, creating ductional deficits in the fellow eye in order to make versions more symmetric should be employed. Chemodenervation and prisms are helpful adjunctive modalities in the management of these patients.

Conclusions: Although multiple procedures may be required, most patients with ocular motor cranial nerve palsies are significantly improved after strabismus surgery, with acceptable alignment in primary gaze and an enlarged field of single binocular vision.

Key words: cranial nerve palsy, paretic strabismus, surgical correction