Combining nasal transposition of split lateral rectus with anteronasal transposition of inferior oblique in 3rd nerve palsy

A 23-year-old-woman with early onset large angle exotropia and hypertropia presented to us for correction of strabismus. She was diagnosed with long-standing oculomotor schwannoma, resulting in complete third nerve palsy. She underwent nasal transposition of split lateral rectus (NTSLR) along with anterior and nasal transposition of inferior oblique. Following the procedure, her ocular alignment was restored; she experienced no diplopia, anterior segment ischemia, or vision-threatening complications. NTSLR involves transposition of split lateral rectus nasally, close to medial rectus insertion. This procedure provides good ocular alignment, in cases of complete limitation of motility. We combined NTSLR with anterior and nasal transposition of inferior oblique for treating the significant hypertropia associated with third nerve palsy in this case.