General Management Goals

Many of the disorders affecting cranial nerves III, IV, and VI are remitting, so management issues involve patient comfort. The most troublesome symptom in disorders of these cranial nerves is binocular diplopia that can be simply managed by having the patient patch one eye. Occluding one eye restricts the patient's visual field and results in a loss of depth perception. For this reason, driving is not recommended. Prism correction can be placed in the spectacle of one or both eyes to eliminate diplopia, at least for a range of eye positions near the primary position of gaze. Prisms bend light rays without altering the vergence of the rays. Corrective prisms are oriented to shift the image of the object of regard to the fovea of the deviating eye. An inexpensive plastic form of a prism can be applied to the patient's own glasses for short-term treatment. If the diplopia is going to be permanent or long lasting, then it is desirable to have the prism ground into the spectacle, because this is optically superior to the paste-on prism.

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