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Updated: Jul 20, 2026

Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Periosteal fixation in third-nerve palsy
Pradeep Sharma1, Madhurjya Gogoi, Sachin Kedar
1Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. drpsharma57@yahoo.com
Purpose:
We present a new technique of anchoring the eyeball to the nasal periosteum using a nonabsorbable suture in acquired isolated third-nerve paresis.
Methods:
This was a case series of 4 consecutive adult subjects with isolated third-nerve paresis. After a 12-mm lateral rectus muscle recession in all 4 subjects, we passed 5-O double-armed polyester (NW683 Ethibond; Ethicon, Division of Johnson and Johnson Ltd., Aurangabad, India) on spatulated needles through the periosteum overlying the anterior lacrimal crest (exposed as in a Dacryocystorhinostomy procedure) at its superior part. The needles were brought anterior to the medial rectus muscle insertion and tightened enough to align the eye in 8-10 prism diopters adducted position.
Results:
Ocular alignment in the primary gaze was satisfactory at 6-12 months of follow up.
Conclusions:
The use of a nonabsorbable polyester suture to anchor the globe to the nasal periosteum is an additional technique that holds promise to align the eyes in the primary gaze.
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