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Published on: March 1, 2015
Initial treatment outcomes in chronic sixth nerve palsy
J M Holmes1, D A Leske, S P Christiansen
1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. holmes.jonathan@mayo.edu
Summary
Management of chronic sixth nerve palsy is challenging, with surgery alone showing a 39% success rate. Botulinum toxin (botox) treatment alone had limited success, highlighting the complexity of treating this condition.
Area of Science:
- Ophthalmology
- Neurology
- Strabismus Management
Background:
- Chronic sixth cranial nerve palsy (paresis) presents a significant management challenge.
- This study evaluated various treatment modalities for long-term sixth nerve palsy.
Purpose of the Study:
- To assess the success rates of conservative management, botulinum toxin (botox) treatment, strabismus surgery, and combined botox-surgery for chronic sixth nerve palsy.
- To compare the efficacy of different interventions in resolving diplopia and esotropia.
Main Methods:
- A prospective, multi-center, nonrandomized data-collection study enrolled 56 patients with sixth nerve palsy >6 months duration.
- Treatments included conservative management, botox, surgery, or combined botox-surgery within 3 months of enrollment.
- Success was defined as absence of diplopia and ≤10 prism diopters esotropia at 6 months post-enrollment.
Main Results:
- Success rates at 6 months were: 15% (conservative), 10% (botox alone), 39% (surgery alone), and 25% (botox + surgery).
- Etiologies included trauma (32%), unknown (27%), neoplastic (25%), diabetic (4%), and other (13%).
- Surgery alone demonstrated the highest success rate among the evaluated interventions.
Conclusions:
- Management of chronic sixth nerve palsy remains challenging, with spontaneous recovery being uncommon.
- Botulinum toxin (botox) monotherapy showed low success rates; single surgical procedures had lower-than-expected efficacy.
- Direct comparison of success rates requires caution due to potential patient selection bias.
