Orbital decompression and frontalis suspension surgery in unilateral exophthalmos and ptosis due to oculomotor nerve palsy

Introduction Congenital oculomotor nerve palsies occur rarely and are classified according to the localization of the lesion. Clinically, external oculomotor nerve palsy is characterized by strabismus and ptosis. Exophthalmos may occur due to the loss of posterior traction of the rectus muscles.

Methods/Material A 15-year-old female patient presented to our clinic with right external oculomotor nerve palsy that had been present since birth. Symptomatically, the patient described pronounced sicca symptoms. Several eye muscle operations had already been performed in the local ophthalmology department without sufficient improvement of the findings. The examination revealed an exophthalmos of the right eye with a Hertel index of 18 mm (left 15 mm). The native CT of the sinuses showed age-appropriate findings. A medial decompression was performed transnasally with opening of the periorbita after ablation of the lamina papyracea. In addition, a frontalis suspension with fascia lata was performed on the affected side.

Results Postoperatively, there was a significant decrease in the Hertel index and an improvement in eyelid closure. The symptoms, especially the dryness of the eye, were regressive.

Conclusion In cases of congenital external oculomotor nerve palsy, medial orbital decompression in combination with frontal suspension can be evaluated as a treatment option. This can reduce the symptoms.

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Artikel online veröffentlicht:
19. April 2024