Ophthalmologic outcome after third cranial nerve palsy or paresis in childhood.

Abstract

PURPOSE:

The purpose of this study was to evaluate the causes and ophthalmologic outcome of oculomotor nerve palsy or paresis in children younger than 8 years of age.

METHODS:

Patients evaluated between 1985 and 1997 were retrospectively reviewed. Data analyzed included vision, residual strabismus after surgery, aberrant reinnervation, binocular function, and anisometropia. Long-term outcome was assessed in patients followed-up longer than 6 months.

RESULTS:

Forty-one patients were identified. The most frequent causes were congenital (39%), traumatic (37%), and neoplastic (17%). Visual acuities were reduced in 71% of patients at the time of the initial visit. Long-term outcome could be assessed in 20 of the 41 patients (49%), with a mean follow-up of 3.6 years (range, 0.5 to 13 years). Visual acuities were reduced because of amblyopia in 35% and nonamblyopic factors in 25% of patients in the long-term outcome group at last follow-up. The best response to amblyopia therapy was in the congenital group, in which all patients improved to normal visual acuity. Strabismus surgery was performed on 8 of 20 children (40%) followed-up, none of whom demonstrated measurable stereopsis after operation despite improved alignment. Aberrant reinnervation was present in 9 of 20 patients (45%). Only 3 patients fully recovered from their oculomotor nerve injuries, and these were the only patients to regain measurable stereopsis. The causes in those 3 patients were congenital, traumatic, and neoplastic.

CONCLUSIONS:

Oculomotor nerve palsy/paresis is associated with poor visual and sensorimotor outcome in children younger than 8 years of age. The best ophthalmologic outcome was in the resolved cases (3 of 20; 15%). Amblyopia therapy was most effective with congenital causes, but treatment results were poor with other causes. Young children with posttraumatic and postneoplastic oculomotor nerve injuries demonstrated the worst ophthalmologic outcomes.

• Authors: A V Mudgil, M X Repka
• Journal: Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus (J AAPOS) Vol. 3 Issue 1 Pg. 2-8 (Feb 1999) ISSN: 1091-8531 [Print] United States
• PMID: 10071894 (Publication Type: Comparative Study, Journal Article)

Topics

• Child
• Depth Perception
• Female
• Follow-Up Studies
• Humans
• Infant
• Infant, Newborn
• Male
• Oculomotor Nerve Diseases (complications, physiopathology, therapy)
• Prognosis
• Refraction, Ocular
• Retrospective Studies
• Vision Disorders (etiology, physiopathology, therapy)
• Visual Acuity