Initial treatment outcomes in chronic sixth nerve palsy

Jonathan M Holmes, David A. Leske, Stephen P. Christiansen

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Introduction: We conducted a prospective multi-center, nonrandomized, data-collection study of patients with chronic sixth cranial nerve palsy. We evaluated success rates with conservative nonsurgical management, botulinum toxin (botox) treatment, strabismus surgery, and a combination of botox treatment and surgery. Methods: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with sixth nerve palsy or paresis of more than 6 months duration over a 2-year period (between March 1998 and February 2000). The botox and surgical groups received intervention within 3 months of enrollment. Success at 6 months from enrollment was defined as absence of diplopia in primary position and no more than 10 prism diopters (pd) distance esotropia in primary position. Patients with no follow-up were excluded. Results: Fifty-six eligible patients were enrolled by 33 investigators. Eighteen (32%) were traumatic in etiology, 15 (27%) were unknown (including presumed hypertensive), 14 (25%) were neoplastic, 2 (4%) were diabetic, and 7 (13%) were other. Twenty (35%) were managed conservatively without surgery, 10 (18%) with botox treatment, 19 (33%) with surgery, and 8 (14%) with a combination of botox treatment and surgery. Success at 6 months from enrollment was 15% in the conservatively managed cases, 10% with botox alone, 39% with surgery alone, and 25% with a combination of botox and surgery. Conclusions: This study demonstrates that management of chronic sixth nerve palsy and paresis remains challenging. Spontaneous recovery occurs but is uncommon. Botox treatment alone was rarely successful, and a single surgical procedure had a lower-than-expected success rate. Care should be taken in directly comparing success rates between treatment groups because of bias in patient selection.

Original languageEnglish (US)
Pages (from-to)370-376
Number of pages7
JournalJournal of AAPOS
Volume5
Issue number6
DOIs
StatePublished - Dec 2001

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Abducens Nerve Diseases
Botulinum Toxins
Paresis
Therapeutics
Esotropia
Diplopia
Strabismus
Patient Selection
Research Personnel

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Initial treatment outcomes in chronic sixth nerve palsy. / Holmes, Jonathan M; Leske, David A.; Christiansen, Stephen P.

In: Journal of AAPOS, Vol. 5, No. 6, 12.2001, p. 370-376.

Research output: Contribution to journalArticle

Holmes, Jonathan M ; Leske, David A. ; Christiansen, Stephen P. / Initial treatment outcomes in chronic sixth nerve palsy. In: Journal of AAPOS. 2001 ; Vol. 5, No. 6. pp. 370-376.
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