The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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Congenital partial third nerve palsy

Photo by Professor Chua Chung Nen

This 19 year-old woman attended the clinic wanting to have her left exotropia corrected. The vision in this eye was 6/36 unaided. The deviation had been present since childhood. Examiantion showed left ptosis with lateral deviation. The extraocular movement was limited mainly on adducation and downgaze with some limitation on upgaze but the pupil was not involved. The ptosis and ocular deviation did not show variability to indicate myasthenia gravis. A CT head scan showed no abnormalities. Orthoptic assessment using prism suggested that she may get post-operative diplopia. After explaining the findings to the patient, she agreeded not to undergo any operations for the time being.

 

Left partial ptosis and extropia.

 

Limited eye movement mainly on adduction and downgaze.

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