Management of third nerve palsyThird nerve palsy (oculomotor nerve palsy) requires a multifaceted approach tailored to the clinical presentation. The goal is to address the underlying cause, alleviate symptoms, and improve ocular alignment and function. The initial step in management is a thorough clinical evaluation to determine the etiology, which may include vascular, traumatic, neoplastic, inflammatory, or idiopathic origins. Neuroimaging and other diagnostic tests are often necessary to identify the underlying pathology. Non-surgical options like prisms and botulinum toxinBotulinum toxin have limited efficacy in complete palsies where occlusive patches can be used to manage diplopia. Surgical intervention aims to align the visual axis in the primary position, and patient expectations must be managed, as postoperative diplopia is common. Various surgical techniquesSurgical technique, such as supramaximal recessionSupramaximal recession and resection, split lateral rectus transpositionSplit lateral rectus transposition, and globe fixation, are used based on the specific characteristics of the palsy. For partial palsies, surgical plans are tailored to optimise the affected eye’s position and movement, often involving contralateral eye surgerySurgery to balance residual deficits. The management of superior and inferior division palsies and single muscle palsies involves specific strategies, including the use of botulinum toxinBotulinum toxin for sensorySensory outcome assessment and a combination of recession and resection procedures. This chapter also discusses the technical details and potential complications of these surgical interventions, supported by case studies illustrating various management approaches.