Background: To analyze the etiology, clinical presentation and outcome of oculomotor nerve paralysis. Materials and Methods: It is a prospective study. All cases for the study is collected from the patients presenting themselves directly to Department of Ophthalmology, some cases are referred from Department of Neurology and Neurosurgery, NRI Medical College and General Hospital, Chinakakani from 2017 to 2019. Results: Most of the patients belong to 51- 60 yrs age group (9) followed by age group 41-50 yrs (7). Among 30 patients right eye was involved in 13 patients, and the left eye was involved in 17 patients. No patients had bilateral palsy. The most common cause of isolated oculomotor cranial nerve paralysis is DM and HTN (microvascular ischemia) in 19 patients. In the present study, out of 9 hypertensives patients with third cranial nerve paralysis eight not recovered and one recovered, out of 21 patients, ten recovered and 11 not recovered. 18 had pupil sparing oculomotor nerve paralysis and 12 had pupil involving paralysis among 30 patients .Patients with pupil sparing oculomotor cranial nerve paralysis recovered completely within six months. Conclusion: Finally we concluded that microvascular ischemia i.e. diabetes and hypertension, incomplete paresis and pupil sparing paralysis has high chances of complete recovery