Paralytic strabismus results from damage to one or more of the motor nerves to the extraocular muscles, which include the third, fourth, and sixth cranial nerves. This type of strabismus requires accurate diagnosis because it may be associated with neurological disease and may necessitate further investigation. Treatment of paralytic strabismus is challenging because ocular rotations are limited, causing the misalignment to vary in different directions of gaze. The goals of treatment are to attain good ocular alignment in the primary position and downgaze, improve the incomitance, expand the field of single binocular vision, and improve compensatory head postures. This chapter discusses the manifestations, epidemiology, pathogenesis, and treatment of paralytic strabismus
