|Year : 1971 | Volume
| Issue : 1 | Page : 40-41
Abnormal regeneration of oculomotor nerve
SK Narang, JK Patel
Department of Ophthalmology, Civil Hospital, Ahmedabad, India
S K Narang
Department of Ophthalmology, Civil Hospital, Ahmedabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Narang S K, Patel J K. Abnormal regeneration of oculomotor nerve. Indian J Ophthalmol 1971;19:40-1
The third nerve is particularly liable to injury from fracture, the pressure of tumor, inlammatory processes and aneurysm. When the nerve regenerates, it has been shown that it has more fibres than were originally present in the nerve. Most of these fibres are misdirected. (Bender and Fulton  ). Fibres destined for one muscle may reach the other muscle. Due to this concept of misdirection of nerve fibres various syndromes have been described. One of these is pseudograefe's syndrome in which there is elevation of the lids on adduction. In 193b Bielschowsky  described five cases of this syndrome., associated with third nerve palsy. He explained it on the basis that some fibres destined for medial rectus go to levator palpebrae superioris. Walsh  has shown that most of the patients who exhibit elevation of the upper lid during adduction, also have ptosis during abduction of the affected eye. He explains this on Sherrington's law of reciprocal innervation of the extraocular muscles. Thus when the external rectus muscle contracts there is diminution of the tone of the internal rectus. Consequently in the instance of regeneration of fibres of oculomotor nerve with misdirection the levator palpabrae has a tonic innervation when the impulses are directed through the third nerve, but when the impulses are directed through the sixth nerve the tonus of the levator is decreased markedly and ptosis results.
| Case Report|| |
R. B. 12 years, Hindu female was brought to the ophthalmic department of S.S.G. Hospital, Baroda with the complaint of diminution of vision both eyes and drooping of the lids for the last 9 years.
On examination, the patient was found to be fairly built and well nourished. She was mentally retarded and had difficulty in walking due to some orthopaedic defect in her leg. Patient was alright at the time of birth but when she was three years old she met with an accident and sustained a head injury for which she had undergone some surgical procedure on the brain. Since then she was having difficulty in walking and eye complaints.
Position of the head was normal. Right eye showed ptosis (Upper lid covering 3 mm. of Cornea) and a divergent squint of about 20° (found by cover and uncover test). The pupil was dilafed and not reacting to light. Extraocular movements were absent on the superior, inferior and medial side but were present on the lateral side (action of the lateral rectus muscle) Left eye was normal. (Plate 1) Vision in both the eyes was finger counting at a distance of 2 metres
When the patent was asked to see on her right side (plate 2) the right eye moved to the right side but the ptosis increased (lid covering 6 mm. of cornea) and there was retraction of the left upper lid thus widening of the left palpeberal fissure.
On asking the patient to look on her left (Plate 3), there was abduction and ptosis of the left eye (upper lid covering 5 mm. of cornea) and retraction of the right upper lid without adduction of the right eye.
On closing the left eye there was complete ophthalmoplegia of the right eye, even the action of the lateral rectus was not noticed.
Closure of the right eye did not produce any abnormality in the left eye.
Fundi were normal in both the eyes.
Peripheral fields were normal.
Total W. B. C. count 7,600/Cu. mm
Differential: Polymorph 76%,
Lymphocytes : 22%, mononuclears 1%: Basophils 1 %.
E.S.R.: 18 mm. /hr.
V.D.R.L. : Non Reactive.
Urine Examination : Nothing abnormal was detected.
X-ray. Skull: An opacity in the frontal region suggestive of an old injury, otherwise nothing abnormal.
| Summary|| |
A case of misdirected regeneration of third nerve fibres have been reported. The unusual feature in this case which we have not been able to explain is the development of complete ophthalmoplegia of right eye on closure of the left eye.
| References|| |
BENDER M. B. & FULTON J. F.: Factors in functional recovery following sections of the oculomotor nerve in monkeys. J. Neurol and Psychol. 1939, 2:. 285-292.
BIELSCHOWSKY A.: Lecture. Of motor anomalies of the eye II, Arch. Ophthal. 1935, 13, 33 - 59.
WALSH F. B.: Clinical Neuro - Ophthal. 1957, p. 194-196. Williams and Wilkins company. Baltimore.
[Figure - 1], [Figure - 2], [Figure - 3]