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TitelInvited lecture : Sixth nerve palsy: diagnosis and treatment
Abstract Nr.2019
DoelSixth nerve (VI) palsy is the commonest isolated ocular motor nerve palsy.
Approximately 60% VI palsies are of presumed microvascular / idiopathic aetiology, with a total recovery occurring in 60% cases in an average time of about 3 months.
Despite this initial relatively ‘benign’ prognosis VI palsy may be caused by a broad range of underlying conditions including serious pathology such as neoplasia and GCA.
Management of VI palsy involves confirmation of the diagnosis, exclusion of any underlying pathology, treatment of any identified underlying cause (including vascular risk factors) and alleviation of diplopia. A meticulous history and examination are key. The role of routine MRI with contrast remains controversial but a low threshold for imaging is advisable.
Diplopia in the initial stages may be managed with occlusion and/or prisms. There is little evidence for the use of BTXA in the acute stage which may also mask signs of progression.
Diplopia in cases of unresolved VI palsies may be treated with BTXA and/or surgery. Choice of surgery depends upon whether the palsy is complete or partial and may be aimed at either the paretic or contralateral eye. Complete palsy requires a transposition of the vertical recti with or without BTXA and/or augmentation (Foster) sutures. Single transposition of the superior rectus combined with ipsilateral medial rectus recession has recently been described and appears a promising technique. The Scott procedure (recess/resect of a rectus muscle) may also be useful. Despite these techniques more than one procedure is often still required.
BelangenverstrengelingNee
Auteur 1
NaamTIFFIN
InitialenP
InstituutSunderland Eye Infirmary
StadSunderland-UK
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