Enhanced adjustable nasal transposition of split lateral rectus muscle for surgical management of oculomotor nerve palsy.

Lateral rectus transposition to the medial rectus muscle has recently generated interest in the management of oculomotor nerve palsy. We report 4 cases of complete oculomotor nerve palsy with a large-angle exotropia that were treated with a modified adjustable nasal transposition of the split lateral rectus muscle. Forced duction testing for the lateral rectus muscle showed good adduction in all 4 cases. Postoperative alignment within 10 in straight-ahead gaze was achieved in all 4 cases; adjustment was required in 2 cases.