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Related Concept Videos

Muscles of the Eye01:20

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Related Experiment Video

Updated: Feb 23, 2026

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
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Early Onset Sixth-Nerve Palsy with Eccentric Fixation.

Kaajal D Nanda1, Eve Lacey1, Alki Liasis2

  • 1From the Eye Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.

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|September 15, 2017
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Summary

Early onset sixth-nerve palsy in children can lead to eccentric fixation, impacting vision. Early surgical intervention is recommended to prevent this visual complication.

Keywords:
early onset sixth-nerve palsyesotropiasixth-nerve palsy

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Area of Science:

  • Ophthalmology
  • Pediatric Neurology
  • Strabismology

Background:

  • Early onset sixth-nerve palsy is a rare condition affecting eye alignment in children.
  • Congenital sixth-nerve palsy can lead to significant visual deficits, including strabismus and amblyopia.
  • Eccentric fixation is a common visual adaptation in cases of early onset paralytic strabismus.

Observation:

  • Four cases of early onset sixth-nerve palsy were reviewed, with three congenital.
  • All patients presented with esotropia and eccentric fixation, often masked until after surgery.
  • MRI revealed abnormalities in three out of four patients.

Findings:

  • Surgical interventions included vertical muscle transposition with Botulinum Toxin A (BTXA) and medial rectus recession with lateral rectus resection.
  • Significant reductions in esotropia were observed postoperatively.
  • Eccentric fixation persisted in some cases, suggesting a complex etiology.

Implications:

  • Congenital sixth-nerve palsy may impair cross-fixation, leading to eccentric fixation.
  • Reverse occlusion was ineffective in correcting eccentric fixation.
  • Early surgical management is crucial to mitigate the development of eccentric fixation and associated visual impairments.