Surgical anatomy of 3rd , 4th and 6th cranial nerves

3.  Introduction
 Anatomy of 3rd nerve
 Anatomy of 4th nerve
 Anatomy of 6th nerve
 Clinical touch
 DD
 Conclusion

19. External Ocular Paralysis
Muscle Direction of
pull
Result of
paralysis
Cranial nerve
Medial rectus Medially Lateral III
Superior
rectus
Upwards Downwards III
Lateral
rectus
Laterally Medial VI
Inferior
rectus
Downwards Upwards III
Superior
oblique
Down and
out
Up and in IV
Inferior
oblique
Up and out Down and in III

21.  A 48 year old woman gradually developed
worsening left eye pain and double vision over
the course of 18 months. Her left pupil
appeared dilated and didnot constrict in
response to light. Her left upper eye lid
drooped about 5 mm lower than right.
 Diagnosis?

24.  Diplopia
 Pain in eyes
 Pain around the eyes
 Nausea
 Vomiting
 Facial asymmetry
 Weakness

25.  Middle aged male with H/O RTA

26.  45 year old female k/c DM and endocarditis
has c/o huge painfull swelling in left eye and
diplopia.

27.  Monocular Diplopia
• Refractive errors including Astigmatism
• Poorly fitting lens
• Corneal abnormalities
• Keratoconus
• Corneal surface abnormalities
• Dry eyes
• Corneal transplant
• Lid abnormalities: chalazion
• Rtinal abnormalities: epiretinal scar

28.  Binocular diplopia
• Cranial nerve palsy
• Meningeal SOL
• DM
• Mysthenia Gravis
• Horner’s syndrome
• Parkinson’s disease
• GB syndrome
• Multiple sclerosis
• Giant cell arteritis