How can double vision be treated?

Prisms added to or incorporated into spec- tacles can realign the images and allow sin- gle binocular vision in straight ahead gaze. Contact numbers Because the degree of the misalignment varies in different gaze positions, prism cor- rection does not eliminate double vision in Orthoptist: every gaze position. The power of prism can be reduced as the palsy improves. St Richard’s Patching one eye eliminates diplopia, how- 01243 788122 ext 3514 ever, this treatment must be carefully moni- tored in children to avoid the development Worthing of amblyopia. 01903 205111 ext 85430 Can sixth nerve palsy be fixed?

After observation for improvement (usually 12 months) surgery may be performed to reduce double vision or to improve the ap- pearance of the eyes. Orthoptic Department

Are there any other associated signs or Information Sheet symptoms? We are committed to making our Hearing loss, facial weakness, decreased publications as accessible as possible. If Sixth (VI) Nerve Palsy facial sensation or droopy eyelids can be you need this document in an alternative associated with VI nerve palsy depending format, for example, large print, Braille or a on the cause. language other than English, please contact the Communications Office by: St Richard’s If you have any of these symptoms please email: [email protected] Hospital mention them to your Orthoptist. or by calling 01903 205 111 ext 84038. Spitalfield Lane Chichester West Sussex www.westernsussexhospitals.nhs.uk PO19 6SE Worthing Hospital Department: Orthoptics Lyndhurst Road Issue date: Nov 2013 Worthing Review date: Nov 2015 West Sussex Leaflet Ref: ORT23 BN11 2DH This leaflet is intended to answer some of occurs during birth. So some patients with VI nerve palsy will the questions of patients or carers of not notice any problem when reading but patients, diagnosed with sixth nerve palsy In older persons; diabetes, blood vessel will have double vision when trying to drive. under the care of Western Susses Hospitals disease or a small stroke are the most common NHS Trust. causes. Sometimes the cause of the palsy is Children under five typically do not not determined despite extensive investigation. experience persistent double vision, but can develop amblyopia (a lazy eye). What is sixth (VI) nerve palsy (Also How is it diagnosed? called lateral rectus palsy or abducens Does sixth nerve palsy improve with nerve palsy)? The orthoptist will examine the eye movements time? Sixth cranial nerve palsy is weakness of the and position of the eyes taking various cranial nerve that innervates (moves) the measurements. Once VI nerve palsy is Yes, in many cases. lateral rectus muscle. The lateral rectus diagnosed you may be asked to have blood muscle pulls the eye away from the nose tests or in some cases a CT or MRI scan. The amount of improvement depends upon and when the lateral rectus muscle is weak, If the doctor knows you are diabetic, have had a the cause. Palsy caused by viral illness the eye turns inwards toward the nose stroke or have other general health risk factors generally resolves completely; as do those (esotropia). then often no further investigations are from diabetes or mild blood vessel disease. Patients with VI nerve palsy are unable to necessary, providing the VI nerve palsy shows move their eye outwards away from the signs of recovery. Your orthoptist will repeat Some patients may experience nose. The degree to which this movement the measurements at regular intervals to improvement but not complete recovery and is affected will vary from person to person monitor any changes. Should your condition may be left a residual muscle weakness. and be complete (no movement at all) or change dramatically in-between appointments The orthoptist and ophthalmologist can partial. you are advised to telephone the Orthoptic advice you on the long-term management department. options available to you. What causes sixth nerve palsy? The most common causes of VI cranial What are the symptoms of sixth nerve Maximum improvement usually occurs nerve palsy are high blood pressure, palsy? during the first six months after onset, but diabetes, TIA (transient ischemic attack or may occur up to 18 months after the start of mini-stroke) or stroke. Other causes may Double vision (2 images seen side by side) is symptoms. include trauma, viral illness, brain tumour, the most common symptom. In right VI nerve inflammation, infection, migraine headache palsy symptoms will be worse when looking to Congenital sixth nerve palsy is unlikely to and elevated pressure inside the brain. the right. resolve spontaneously.

The condition can be present at birth; There is usually less double vision on near however, the most common cause in fixation than on distant fixation. children is trauma sometimes that which