What are the medical treatment options for abducens nerve palsy (sixth cranial nerve palsy)?

Updated: Nov 19, 2018
  • Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Truly isolated cases of abducens nerve palsy are often benign. They can be followed with a serial examination, at least every 6 weeks, over a 6-month period to note decreasing symptoms (diplopia) and resolution of the paretic lateral rectus (increasing motility). [12, 3] Prism measurements are a simple objective method of documenting any changes in the esotropia.

Children with sixth nerve palsy who are in the amblyopic age group can be treated with an alternating patching to decrease their chances of developing any amblyopia in the paretic eye. Additionally, prescribing the full amount of hyperopic correction helps to decrease the esodeviation by relaxing the child's accommodative effort.

Adult patients and those children beyond the amblyopic age can be patched or have their lenses "fogged" with clear tape or nail polish to reduce their diplopia. Fresnel prisms also can be prescribed as an alternative.

Older patients in whom giant cell arteritis is suspected should start the standard treatment with prednisone or intravenous methylprednisolone.

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