Bifocal fabrication to facilitate comfortable vision in a patient with limited motility and to provide accommodation from third cranial nerve palsy is described. A traditional bifocal prescription with hyperopic astigmatism was written 90° off axis. Instructions were given to the optician to rotate the lens 90° counterclockwise to place a small bifocal temporally for best distance correction and occasional reading and 90° clockwise in a second pair of glasses to place a large bifocal at the center for sustained reading, with a small window of correction temporally for distance viewing. This scheme allowed a patient whose only ocular movement was only a few degrees of abduction and who had no accommodation to comfortably wear distance and near correcting bifocal glasses.
Report of a Case.
A 23-year-old woman with unilateral congenital third nerve palsy involving accommodation requested bifocals. Because motility in her only seeing eye was limited to 15° of abduction,
Fahad B, Helveston EM. Horizontal Displacement of the Reading Addition in Third Nerve Palsy. Arch Ophthalmol. 1997;115(2):276–278. doi:10.1001/archopht.1997.01100150278025
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