Botulinum Toxin Type A as an Early Intervention for Traumatic Oculomotor Nerve Palsy: A Pediatric Case Report

Traumatic third cranial nerve palsy is a rare complication of head injury, with an incidence of approximately 1% and a characteristically poor prognosis. Conventional management remains conservative, often yielding unsatisfactory outcomes. We report the case of a 13-year-old girl who developed complete right third cranial nerve palsy following a 15-meter fall, presenting with exotropia (35Δ), ptosis, complete ophthalmoplegia, and pupillary dysfunction. Brain CT revealed hemorrhage in the right cavernous sinus, and subsequent MRI demonstrated focal nerve damage. Thirty-eight days post-injury, a single botulinum toxin type A (BTX-A) injection (5 units) was administered to the right lateral rectus muscle. Progressive improvement in ocular alignment and motility was observed, with resolution of diplopia by 4.5 months and sustained orthotropia at 10 months post-injury. Although pupillary dilation persisted, functional recovery was substantial. This case demonstrates that early BTX-A intervention may prevent lateral rectus contracture and promote functional recovery in traumatic third cranial nerve palsy. BTX-A represents a promising minimally invasive therapeutic option that warrants further investigation in larger patient populations.