eMedicine Specialties > Ophthalmology > Extraocular Muscles

Abducens Nerve Palsy: Differential Diagnoses & Workup

Author: Michael P Ehrenhaus, MD, Director, Department of Cornea, External Disease & Refractive Surgery, Assistant Professor, Department of Ophthalmology, State University of New York Downstate Medical Center
Coauthor(s): Mohammedyusuf E Hajee, MD, Clinical Instructor, Staff Physician, Department of Ophthalmology, Director, Blood Flow Laboratory, State University of New York-Downstate Medical Center; Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Contributor Information and Disclosures

Updated: May 21, 2009

Differential Diagnoses

Giant Cell Arteritis
Orbital Fracture, Medial Wall

Other Problems to Be Considered

Isolated abducens nerve palsy
Break in the fusion of a patient with congenital esophoria

Workup

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

Imaging Studies

  • Skull series
    • Stereoscopic submental-vertex basal view of the skull (to inspect the basal foramina)
    • If no marked improvement after 6 weeks or if other cranial nerves become involved, then a more thorough evaluation is indicated, such as a full medical and neurologic workup, CT scan with and without contrast, MRI, LP, and cerebral angiography.
  • MRI 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.

Other Tests

  • Check history for diabetes mellitus, cancer, thyroid disease, and hypertension.
  • Ask about history of recent trauma, ear infections (children), and fluctuation of symptoms.
  • An otoscopic examination may be performed in children to rule out a complicated otitis media (consider an LP).
  • Rule out other cranial nerve involvement.

Procedures

  • A temporal artery biopsy may be indicated if findings and laboratory studies suggest giant cell arteritis.

More on Abducens Nerve Palsy

Overview: Abducens Nerve Palsy
Differential Diagnoses & Workup: Abducens Nerve Palsy
Treatment & Medication: Abducens Nerve Palsy
Follow-up: Abducens Nerve Palsy
References
[ CLOSE WINDOW ]

References

  1. Evans NM. Ophthalmology. 2nd ed. Oxford University Press Inc; 1995.

  2. Kline LB, Bajandas FJ. Neuro-ophthalmology Review Manual. 3rd ed. University of Alabama, Birmingham; 1988.

  3. Yanoff M, Duker JS. Ophthalmology. Mosby International Ltd; 1999.

  4. Ayberk G, Ozveren MF, Yildirim T, et al. Review of a series with abducens nerve palsy. Turk Neurosurg. Oct 2008;18(4):366-73. [Medline].

  5. Denis D, Dauletbekov D, Girard N. Duane retraction syndrome: Type II with severe abducens nerve hypoplasia on magnetic resonance imaging. J AAPOS. Feb 2008;12(1):91-3. [Medline].

  6. Calisaneller T, Ozdemir O, Altinors N. Posttraumatic acute bilateral abducens nerve palsy in a child. Childs Nerv Syst. Jul 2006;22(7):726-8. [Medline].

  7. Dwarakanath S, Gopal S, Venkataramana NK. Post-traumatic bilateral abducens nerve palsy. Neurol India. Jun 2006;54(2):221-2. [Medline].

  8. Kurbanyan K, Lessell S. Intracranial hypotension and abducens palsy following upper spinal manipulation. Br J Ophthalmol. Jan 2008;92(1):153-5. [Medline].

  9. Hanu-Cernat LM, Hall T. Late onset of abducens palsy after Le Fort I maxillary osteotomy. Br J Oral Maxillofac Surg. Dec 16 2008;[Medline].

  10. Anwar S, Nalla S, Fernando DJ. Abducens nerve palsy as a complication of lumbar puncture. Eur J Intern Med. Dec 2008;19(8):636-7. [Medline].

  11. Rhee DJ, Pyfer MF. The Wills Eye Manual: Office and Emergency Room diagnosis and treatment of eye disease. Lippincott Williams & Wilkins; 1999.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

abducens nerve palsy, sixth nerve palsy, VI nerve palsy, 6th nerve palsy, cranial nerve VI palsy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Michael P Ehrenhaus, MD, Director, Department of Cornea, External Disease & Refractive Surgery, Assistant Professor, Department of Ophthalmology, State University of New York Downstate Medical Center
Michael P Ehrenhaus, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Contact Lens Association of Ophthalmologists
Disclosure: Nothing to disclose.

Coauthor(s)

Mohammedyusuf E Hajee, MD, Clinical Instructor, Staff Physician, Department of Ophthalmology, Director, Blood Flow Laboratory, State University of New York-Downstate Medical Center
Mohammedyusuf E Hajee, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, and National Medical Association
Disclosure: Nothing to disclose.

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Andrew W Lawton, MD, Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center
Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Brian R Younge, MD, Professor of Ophthalmology, Mayo Clinic School of Medicine
Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

James P Gills, MD, Founder, St Luke's Cataract and Laser Institute; Professor, Department of Ophthalmology, University of South Florida College of Medicine
James P Gills, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.