Vertical misalignment in unilateral sixth nerve palsy1 Historical image☆,
Section snippets
Material and methods
Twenty-seven consecutive patients with unilateral sixth nerve palsy were recruited from the Neuro-ophthalmology Unit at the University Health Network, Toronto, Ontario, Canada. A complete history was taken, and detailed ophthalmic and neurologic examinations were performed. The age of onset, the presence or absence of risk factors for ischemia (diabetes mellitus and hypertension), duration of diplopia, range of duction, horizontal and vertical deviations (see Orthoptic Assessment ), and
General characteristics of patients
Twenty patients had peripheral palsy caused by an idiopathic, presumed ischemic, peripheral lesion (Table 1). The mean age was 61 ± 14 years (age range, 21–77 years; median age, 64 years); 11 of them were men. The duration of symptoms ranged from 2 weeks to 96 months, with a mean duration of 20 ± 17 months. Mean follow-up duration was 10 months (range, 8–22 months). Fourteen had normal MR imaging and six had normal CT scanning of the brain. Five of the six patients with normal CT scan had
Discussion
Information about vertical strabismus in sixth nerve palsy is sparse. Kestenbaum1 stated that “in abducens paresis a vertical component is sometimes found,” and this slight vertical component can be up to 3 diopters before one can conclude that a vertical muscle is involved pathologically.1 Smith2 cited Dr. F. Walsh, stating that “one could accept up to 2 to 3 prism diopters of vertical deviation with a VI nerve palsy alone, but any amount more than that was significant.”2 They1, 2 did not
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Cited by (32)
Orbital Fractures With Concomitant Ocular Nerve Palsy: An Insidious and Potentially Misleading Association in Surgical Decision-Making
2022, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :However, it should be remembered that the entrapment of the medial rectus or the lateral rectus muscles, in cases with concomitant medial wall or lateral wall fractures, respectively can also mimic such a paralysis picture. Moreover, it has been reported that in patients with central brainstem abducens paralysis, a vertical misalignment can be found.22 The main strength of the present study was that it is the largest case series reported on the association of OFs and concomitant TONP.
Pickwell’s Binocular Vision Anomalies
2021, Pickwell's Binocular Vision AnomaliesEye Movement Disorders: Third, Fourth, and Sixth Nerve Palsies and Other Causes of Diplopia and Ocular Misalignment
2018, Liu, Volpe, and Galetta's Neuro-Ophthalmology: Diagnosis and ManagementHypertropia in unilateral isolated abducens palsy
2014, Journal of AAPOSCitation Excerpt :This is consistent with Slavin's results of 56% of patients having hypertropia ipsilateral to abducens palsy.3 Wong and colleagues4 found no correlation between laterality of abducens palsy and hypertropia and no variation in hypertropia consistent with associated vertical rectus or oblique muscle paresis in their patients with abducens palsy, but in contrast to the current report, they found the hypertropia to be comitant.4 Absence of significant incomitance could be due to Wong and colleagues' small sample size.4
Lateral rectus superior compartment palsy
2014, American Journal of OphthalmologyPiercings, phorias and postural control: A case report
2014, Revue Francophone d'Orthoptie
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Supported by the E. A. Baker Foundation (Canadian National Institute for the Blind Toronto, Canada), the Visual Science Research Program (University of Toronto, Ontario, Canada), and Canadian Institutes of Health Research Ottawa, Canada (Grants MT 15362 and ME 5504).
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The authors have no commercial interests in any products described in this article.