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Surgical approach for traumatic chiasmal syndrome and complete third nerve palsy following severe head trauma
  1. Mariana Portela1,
  2. Tiago Lorga2,
  3. Joana Portelinha1 and
  4. João Marques Costa1
  1. 1Ophthalmology, CHLO, Lisboa, Portugal
  2. 2Neuroradiology, CHLO, Lisboa, Portugal
  1. Correspondence to Dr Mariana Portela; marianasportela{at}


Traumatic chiasmal syndrome and traumatic third nerve palsies are rare entities usually caused by severe, high-speed, closed-head road accidents that require a thorough diagnostic work-up and complex medical and surgical management. This report presents the case of a young adult who was involved in a motorcycle accident and sustained blunt frontal head trauma, resulting in optical chiasmal syndrome and complete unilateral third nerve palsy. Ophthalmological examination demonstrated a right complete ptosis, a downward and outward position of the right eye with a fixed and dilated pupil, and bitemporal hemianopsia. In addition, funduscopy revealed bilateral optical nerve atrophy. After stabilisation and during follow-up, strabismus surgery was performed with improvement of ocular alignment in the primary position. Subsequently, eyelid surgery was carried out with good amplification of the visual field, particularly on the left side. Although challenging, surgical intervention in these cases should be considered for both functional and cosmetic reasons.

  • Cranial nerves
  • Neuroopthalmology
  • Neuroimaging
  • Trauma
  • Visual pathway

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  • Contributors The detailed contributorship for each author is as follows: MP and TL: conceptualisation and design, methodology, investigation, acquisition of data, analysis and interpretation of data, software and writing (original draft). JP and JMC: conceptualisation and design, methodology, investigation, analysis and interpretation of data, project administration, supervision and writing (review and editing). All authors agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.