This 50-year-old man presented with acute 3rd nerve palsy involving the pupil and a ptosis. He was radiographically diagnosed with Schwannoma of the 3rd cranial nerve. The deviation was stable for over a year and he had diplopia when he lifted the ptotic eyelid. It was decided that he has to undergo a combination of strabismus and lid surgery and this video demonstrates the strabismus part of the surgery. The 3rd nerve is paretic, so the eye was turned out because of the still functioning lateral rectus muscle and the eye was turned down because of the still functioning superior oblique muscle.

During the forced duction test in the clinic, the eye was found to have positive forced duction test because the lateral rectus muscle had become tight and contracted. In order to relieve the restriction of the tight lateral rectus muscle, the muscle was disinserted and fixed to the periosteum. The superior oblique muscle was transposed from its superio-temporal retro-equatorial behind the equator location and was reimplanted adjacent to the insertion of the medial rectus muscle. The superior oblique muscle was transformed from an abduction muscle to an adducting muscle. In order to increase the passive strength, a large resection of the medial rectus was done.

Surgery Location: on-board the Orbis Flying Eye Hospital in Addis Ababa, Ethiopia
Surgeon: Dr. Douglas Fredrick, Mount Sinai School of Medicine, USA

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October 31, 2018

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