Thank you for your question:
As you already know, the incomitant misalignment is due to the multiple partial cranial nerve palsies. It is often difficult to correct such incomitant strabismus
with prism. However, it can be corrected with surgery after careful evaluation by a strabismus eye surgeon. The approach would be first to determine that the amount of misalignment in the various direction is stable, and not still changing. In order words, is the incomitant deviations stable. If the incomitant deviations are stable based on reproducible diopter measurements, then recession and/or resect procedures of the eye muscles
will be performed. Considering the multiple muscle involvement such as including medial rectus, inferior rectus, superior rectus, lateral rectus, inferior oblique and/or superior oblique muscles, it is very likely the multiple sessions of the surgery will be necessary to get the eyes corrected. I'm assuming that the skull base tumor has been removed and other further compression or extension is affecting the eye. This is can be corrected with patience in the hand of an experience eye surgeon.
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