Sixth nerve palsy

Background

• Most common ocular nerve palsy
• Innervates the ipsilateral lateral rectus muscle controlling eye abduction
• Esotropia of the affected eye due to the unopposed action of the medial rectus muscle

Clinical Features

• Frequently present with diplopia and esotropia
• 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

• POC glucose
• CBC
• BMP
• CT/MRI Brain
• ESR
• Lyme Titer
• RPR

Disposition

Dispo appropriate to etiology, consult either Neuro or Ophtho.

See Also

• Ocular palsy
• Cranial nerves