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Do steroids improve outcomes of idiopathic sixth nerve palsy in children?
Amir Sternfeld1,2, Lee Goren3,4, Miriam Ehrenberg5,3
1Ophthalmology Unit, Schneider Children's Medical center of Israel, 39 Jabotinski St, Petach Tikva, Israel. shtery@gmail.com.
Insights
Systemic steroids may help prevent residual comitant esotropia (RCE) in children with benign acquired isolated sixth nerve palsy (BAISNP). Steroid treatment did not affect healing or recurrence rates but significantly reduced RCE development.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Endocrinology
Background:
- Benign acquired isolated sixth nerve palsy (BAISNP) is a common cause of acquired strabismus in children.
- While most cases resolve spontaneously, some may lead to long-term complications like residual comitant esotropia (RCE).
- The role of systemic steroid treatment in managing BAISNP and its sequelae remains debated.
Purpose of the Study:
- To evaluate the efficacy of systemic steroid treatment in children diagnosed with BAISNP.
- To analyze the impact of steroids on healing time, recurrence rates, and the development of late sequelae, specifically RCE.
- To determine if early steroid intervention influences long-term visual outcomes.
Main Methods:
- A retrospective cohort study was conducted, reviewing data from 27 children diagnosed with BAISNP between 2016 and 2024.
- Data collected included demographics, age at presentation, clinical examination findings, neuroimaging results, treatment strategies, recovery periods, and recurrence data.
- Systemic steroids (prednisolone 1 mg/kg/day for 10 days) were administered to a subset of patients.
Main Results:
- Complete resolution of BAISNP occurred in all patients within an average of 3.2 months.
- Recurrences were observed in 33% of children, with an average resolution time of 1.8 months.
- Systemic steroid treatment did not significantly alter healing time or recurrence rates but was associated with a significantly lower incidence of RCE (6% vs. 45%, p=0.026).
Conclusions:
- Systemic steroid administration during the acute phase of BAISNP is associated with a reduced risk of developing residual comitant esotropia.
- Steroids did not impact the overall resolution rate or the frequency of recurrences.
- Early intervention with systemic steroids may be a valuable strategy to mitigate long-term ocular misalignment in pediatric BAISNP.
Purpose:
To analyze the effect of systemic steroid treatment in children with benign acquired isolated sixth nerve palsy (BAISNP) regarding healing, recurrence risk and late sequelae.
Methods:
A retrospective cohort design was used. The clinical database of a single medical center was reviewed for all children with BAISNP between 2016 and 2024. Data were collected as follows: demographics, age at initial presentation, complete eye and neurological examinations at presentation and every follow-up visit, neuroimaging and LP findings, treatments at presentation or for residual ocular misalignment, recovery periods and recurrences. Systemic steroids (1 mg/kg/day oral prednisolone for 10 days) were recommended by certain physicians, to whom some patients were randomly assigned.
Results:
Twenty-seven children were included in the study. Mean age at presentation was 2.6 ± 2.2 years with a follow-up of 2.0 ± 2.3 years. BAISNP completely resolved after 3.2 ± 3.1 months in all children. Nine children (33%) had a recurrence that resolved after 1.8 ± 0.7 months. Residual comitant esotropia (RCE) exceeding 10 prism diopters persisted in six children (22%) despite resolution of the abduction weakness. Three of them underwent surgery and none regained stereopsis. Fifteen children (56%) received systemic steroids upon presentation. Steroid treatment affected neither time to resolution nor recurrence rate. However, fewer children treated with steroids developed RCE (6% vs. 45%, p = 0.026). A multivariable analysis for RCE development found that only steroids had a statistically significant impact (β=-0.58, p = 0.006).
Conclusions:
Systemic steroids reduce the rates of RCE when administered during an acute episode of BAISNP.
