Contralateral eye surgery with adjustable suture for management of third nerve palsy with aberrant regeneration

Aberrant regeneration of the third nerve following its palsy is commonly seen after trauma and compressive lesions. This phenomenon is thought to result due to misdirection of the regenerating axons. Surgical management is a great challenge in the third nerve palsy owing to multiple muscle involvement and is often accompanied by ptosis and poor Bell's phenomenon. We present a case of a 27-year-old male who developed isolated complete third nerve palsy of the left eye following head trauma. Features of aberrant regeneration were seen after 6 months, namely, inverse Duane's sign and Pseudo-Von Graefe's sign. He underwent recess-resect procedure in the unaffected eye with adjustable suture technique which not only corrected the deviation but also the ptosis by utilizing the oculomotor synkinesis. Thus, contralateral eye surgery combined with adjustable suture technique resulted in an accurate alignment of the eye and obviated the need for ptosis correction.