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Sixth Nerve Palsy How can double vision be treated? Prisms added to or incorporated into spectacles can realign the images and allow single binocular vision in straight ahead gaze. Because the degree of the misalignment varies in different gaze positions, prism correction does not always eliminate double vision in every gaze position. The power of prism can be Contact numbers reduced as the palsy improves. Patching one eye eliminates double vision, however, Orthoptist: this treatment must be carefully monitored in children to avoid the development of St Richard’s amblyopia. 01243 831499 Can long-term sixth nerve palsy be fixed? Southlands 01273 446077 After observation (usually 12 months), surgery may be performed to reduce double vision or to improve the appearance Orthoptic Department of the eyes. Information Sheet Are there any other associated signs or We are committed to making our publications symptoms? as accessible as possible. If you need this Sixth (VI) Nerve Palsy document in an alternative format, for example, Hearing loss, facial weakness, decreased large print, Braille or a language other than facial sensation or droopy eyelids can be English, please contact the Communications associated with VI nerve palsy depending Office by email: [email protected] St Richard’s Hospital on the cause. or speak to a member of the orthoptic team. Spitalfield Lane Chichester If you have any of these symptoms please West Sussex mention them to your Orthoptist. www.westernsussexhospitals.nhs.uk PO19 6SE Department: Orthoptics Issue date: March 2018 Southlands Hospital Review date: March 2020 Upper Shoreham Road Leaflet Ref: ORT23 Shoreham-by-Sea West Sussex BN43 6TQ This leaflet is intended to answer some of Other causes may include trauma, viral illness, Depending on the severity some patients the questions of patients or carers of brain tumour, inflammation, infection, migraine will be symptom-free for close work or when patients, diagnosed with sixth nerve palsy and elevated pressure inside the brain. These looking to one side. under the care of Western Susses Hospitals are seen less frequently. NHS Foundation Trust. Children under five typically do not Sometimes the cause of the palsy is not experience persistent double vision, but can determined despite extensive investigation. develop amblyopia (reduced vision) in one What is sixth (VI) nerve palsy? eye. Sixth nerve palsy is weakness of the cranial How is it diagnosed? nerve that innervates (moves) the lateral Does sixth nerve palsy improve with rectus muscle. The lateral rectus muscle The orthoptist will examine the eye movements time? pulls the eye away from the nose and and position of the eyes taking various when the lateral rectus muscle is weak, the measurements. Once a VI nerve palsy is Yes, in many cases. eye turns inwards toward the nose diagnosed you may be asked to have blood (esotropia). tests or in some cases a CT or MRI scan. The amount of improvement depends upon If the doctor knows you are diabetic, have had a the cause. Palsy caused by viral illness Patients with VI nerve palsy are unable to stroke or have other general health risk factors generally resolves completely; as do those move their eye outwards away from the then often no further investigations are from diabetes or mild blood vessel disease. nose. The degree to which this movement is necessary, providing the VI nerve palsy shows affected will vary from person to person and signs of recovery. Some patients may experience may be complete (no movement at all) or improvement but not complete recovery and partial. Your orthoptist will repeat the measurements at may be left a residual muscle weakness. regular intervals to monitor any changes. The orthoptist and ophthalmologist can What causes sixth nerve palsy? Should your condition change dramatically advice you on the long-term management The most common causes of VI nerve palsy between appointments you are advised to options available to you. are; telephone the Orthoptic department. Maximum improvement usually occurs In children; during the first six months after onset, but Congenital (present from birth) What are the symptoms of sixth nerve may occur up to 18 months after the start of Trauma palsy? symptoms. In older adults; Double vision is the most common symptom. Congenital sixth nerve palsy is unlikely to High blood pressure The double vision may be worse when looking resolve spontaneously. Diabetes to one side and is when looking into the TIA (Transient Ischemic Attack) distance. Stroke .
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