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Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI (the abducens nerve), which is responsible for causing contraction of the lateral rectus muscle to abduct (i.e., turn out) the eye. [1]
The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocular muscles responsible for outward gaze. It is a somatic efferent nerve.
This nerve supplies the muscle that pulls the eye outward. Those with sixth nerve palsy therefore experience horizontal double vision which is worse when looking towards the affected side. More rarely, the oculomotor nerve and trochlear nerve (third and fourth nerve palsy, respectively) are affected; both play a role in eye movements.
The lateral rectus is the only muscle supplied by the abducens nerve (CN VI). The neuron cell bodies are located in the abducens nucleus in the pons.These neurons project axons as the abducens nerve which exit from the pontomedullary junction of the brainstem, travels through the cavernous sinus and enter the orbit through the superior orbital fissure.
Lesions anywhere in the abducens nucleus, cranial nerve VI neurons, or interneurons can affect eye movement towards the side of the lesion. Lesions on both sides of the abducens nucleus can cause a total loss of horizontal eye movement. [6] One other type of gaze palsy is a horizontal saccadic palsy.
Ptosis, chemosis, cranial nerve palsies (III, IV, V, VI). Sixth nerve palsy is the most common. Sensory deficits of the ophthalmic and maxillary branch of the fifth nerve are common. Periorbital sensory loss and impaired corneal reflex may be noted.
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Esotropia (convergent strabismus) may also be caused by sixth nerve palsy, which causes weakness or paralysis of the lateral rectus muscle. [6] Sometimes, botulinum toxin may be injected into the medial rectus muscle. [6] Whilst this reduces the ability to abduct and adduct the eye for tracking, it corrects the esotropia and so generally ...