78 year old M with history of recent left supraorbital crani | Figure 1

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Patient Case

A 78 year old M with history of recent left supraorbital craniotomy for resection of a pituitary tumor presented with a complaint of inability to open the left eye immediately following surgery. Photos demonstrate attempted eyelid opening, primary gaze, and vertical and horizontal eye movements. There is complete left ptosis, mydriatic and non-reactive left pupil without RAPD and intact consensual response of the right pupil, and only preserved abduction of the left eye on attempted left gaze. In primary gaze, the left eye is “down and out.” No aneurysm or other intracranial vascular abnormality was noted on imaging. Approximately 10% of acquired third cranial nerve palsies are iatrogenic, resulting from neurosurgical intervention.