Poster 3: Successful Prism Treatment in Two Cases of Isolated Oculomotor Nerve Palsy

Background

An oculomotor (third cranial nerve) palsy results from damage to the oculomotor nerve anywhere along its course in the brain. Both congenital and acquired forms can be total or partial, causing variances of pupil, eyelid, and extraocular muscle abnormalities. Ocular motility is drastically affected by oculomotor nerve palsies with limitation of elevation, depression, and adduction.

Case Reports

We compared diagnosis and treatment of 2 adult females with long-standing oculomotor nerve palsies; 1 acquired and 1 congenital. The acquired-onset patient had been in a motor vehicle accident 41 years prior. She was suffering from diplopia that was reduced by tilting her head. The head tilt led to torticollis and eventually caused gradually worsening neck pain. The patient with congenital oculomotor palsy did not experience diplopia but had rather unusual episodes of visual disturbance accompanying eye pain and headaches. She had cyclical spasms, whereby the magnitudes of her ptosis and eye turn were variable throughout the day. Gradual worsening of her symptoms had prompted her to seek treatment.

Conclusion

Although these patients exhibited vastly different symptoms, both experienced relief by incorporating yoked prism into their spectacles. Moderate amounts of yoked prism were used to eliminate diplopia and lessen the head tilt in the case of the acquired third nerve palsy. Small amounts of yoked prism and limited vision therapy re-established an appropriate visual-spatial projection in the case of the congenital third nerve palsy. The patient experienced considerable relief from her visual disturbances and ocular pain.