Sixth nerve palsy

Background

Palsy of the abducens nerve, CN VI, is the most common ocular nerve palsy. The abducens nerve innervates the ipsilateral lateral rectus muscle, controlling eye abduction. A palsy results in an esotropia of the affected eye due to the unopposed action of the medial rectus muscle.

Clinical Features

Patients with a CN VI palsy frequently present with diplopia and esotropia. They may have a head turn to help correct their diplopia.

Differential Diagnosis

• Giant Cell Arteritis
• Medial Orbital Fracture (with entrapment of the medial rectus muscle)
• ocular Myasthenia Gravis
• Miller-Fisher Syndrome Guillian-Barre Syndrome
• Congenital Esotropia
• Meningitis

Management

• CBC
• BMP
• Accucheck
• CT/MRI Brain
• ESR
• Lyme Titer
• RPR

Disposition

Dispo appropriate to etiology, consult either Neuro or Optho.

See Also

• Ocular palsy
• Cranial nerves