[Synkinesia of the internal eye muscles in congenital third nerve paralysis]

Synkinetic lid and ocular movements after traumatic or non-traumatic, acquired oculomotor palsy are well known. Less often misdirection in the intraocular muscles is observed. A 20-year-old female patient suffered from congenital palsy of the third nerve of the left dominant eye. She had residual small-angle exotropia after having extraocular muscle surgery four times during childhood, e.g., after high-dosage recess-resect procedures on the horizontal recti of her left eye. There was an anisocoria with a miotic pupil in the left eye when fixating in the primary position and when attempting right gaze. The patient complained of blurred vision at far fixation in the primary position. Her visual acuity was 0.8 in the primary position and 1.25 in 7 degrees left gaze. Retinoscopy of the left eye revealed a 1-1.25 myopic increase for the primary position. Surgical and non-surgical treatment (e.g., cycloplegia plus bifocal glasses, induced change of the leading eye) is discussed.