1. Abducent Nerve ParalysisAbducent Nerve Paralysis
Faculty of MedicineFaculty of Medicine
Ain Shams UniversityAin Shams University
Ophthalmology DepartmentOphthalmology Department
Unit of Prof.dr.Magdy ElbarbryUnit of Prof.dr.Magdy Elbarbry
Under Supervision Of:Under Supervision Of:
Dr.Rafaat RehanDr.Rafaat Rehan

2. Points to BePoints to Be
CoveredCovered
• Anatomy of Abducent NerveAnatomy of Abducent Nerve
• Pathophysiology& DemographicsPathophysiology& Demographics
• CausesCauses
• Clinical PictureClinical Picture
• Work UpWork Up
• TreatmentTreatment

3. AbducentAbducent
NerveNerve
AbducentAbducent
NerveNerve
AnatomyAnatomy

4. Abducent NerveAbducent NerveAbducent NerveAbducent Nerve

5. Abducent NerveAbducent NerveAbducent NerveAbducent Nerve

6. Action Of Lateral Rectus MuscleAction Of Lateral Rectus Muscle

7. Pathophysiology& DemographicsPathophysiology& Demographics
Only the ipsilateral lateral rectus that is solely innervated by the
involved peripheral sixth cranial nerve is affected; therefore,
only deviations in the horizontal plane are produced.
Age
• Cranial nerve VI palsy can occur in all age groups; however, the
etiology varies depending on the age group.
Sex:
• Sixth nerve palsies have no predilection for males or females
•
Abducent Nerve ParalysisAbducent Nerve Paralysis

8. NuclearNuclear
FascicularFascicular
SubarachnoidSubarachnoid
PetrousPetrous
Cavernous
sinus and
superior
orbital fissure
Cavernous
sinus and
superior
orbital fissure
OrbitalOrbital
Causes ofCauses of
AbducentAbducent
PalsyPalsy
Causes ofCauses of
AbducentAbducent
PalsyPalsy

9. Clinical PictureClinical Picture
History
Clinical history includes the following:
Esotropia
Head-turn
Binocular diplopia (worse at distance)
Vision loss
Hearing loss
Symptoms of vasculitis, particularly giant cell arteritis
Trauma
•

10. EsotropiaEsotropia

11. Binocular DiplopiaBinocular Diplopia
NormalNormal HorizontalHorizontal
DiplopiaDiplopia

12. Binocular DiplopiaBinocular Diplopia

13. Physical
Physical findings include the following:
An esodeviation that increases on
ipsilateral gaze and is often greater at a
distance
An isolated abduction deficit
Papilledema (if increased intracranial
pressure)
Nystagmus (usually in children, ie,
secondary to pontine glioma)
Otitis media
Orbital wall fracture
Tender, enlarged, nonpulsatile temporal
arteries in giant cell arteritis
•

14. An esodeviation thatAn esodeviation that
increases on ipsilateralincreases on ipsilateral
gaze and is often greatergaze and is often greater
at a distanceat a distance
Past PointingPast Pointing

15. Work UpWork Up• Laboratory Studies
Complete blood cell (CBC) count
Glucose levels
Glycosylated hemoglobin (HbA1C)
Erythrocyte sedimentation rate and/or C-
reactive protein
Rapid plasma reagin test
Fluorescent treponemal antibody-absorption
test
Lyme titer
Glucose tolerance test
Antinuclear antibody test
•

16. Work UpWork UpMRI is indicated for the following:
Patients younger than 45 years
Associated pain or other neurologic abnormality
History of cancer
Bilateral sixth nerve palsy
Papilledema
Patients younger than 55 years with no
vasculopathic history
In the event no marked improvement is seen or
other nerves become involved
An LP should be considered if MRI results are negative.

17. • Consultations
With persistent defect, a neurology consult may be needed.
•
• Activity
Patients who occlude an eye to alleviate diplopia should be
warned that the resulting effects on depth perception may
interfere with their ability to drive or perform certain
occupations safely.
•
• Complications
Persistent esotropia may require a surgical procedure.
•
• Prognosis
This condition generally resolves within 6 months.

18. Medical CareMedical Care
• Truly isolated cases often are 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).
•

19. Medical CareMedical Care
Children with sixth nerve palsy who are inChildren with sixth nerve palsy who are in
the amblyopic age group can be treatedthe amblyopic age group can be treated
with an alternating patching to decreasewith an alternating patching to decrease
their chances of developing anytheir chances of developing any
amblyopia in the paretic eye.amblyopia in the paretic eye.

20. Additionally, prescribing theAdditionally, prescribing the
full amount of hyperopicfull amount of hyperopic
correction helps to decreasecorrection helps to decrease
the esodeviation by relaxingthe esodeviation by relaxing
the child's accommodativethe child's accommodative
effort.effort.

21. Surgical CareSurgical Care

22. RecessionRecession ResectionResection
Surgical CareSurgical Care

23. Surgical CareSurgical Care

25. Thanks' For AttentionThanks' For Attention
Abducent Nerve ParalysisAbducent Nerve Paralysis
Faculty of MedicineFaculty of Medicine
Ain Shams UniversityAin Shams University
Ophthalmology DepartmentOphthalmology Department
Unit of Prof.dr.Magdy ElbarbryUnit of Prof.dr.Magdy Elbarbry
Under Supervision Of:Under Supervision Of:
Dr.Rafaat RehanDr.Rafaat Rehan
Team Work:Team Work:
(46)Ahmed Adel(46)Ahmed Adel
(48)Ahmed Adel Fouad(48)Ahmed Adel Fouad
(49)Ahmed Adel(49)Ahmed Adel