Sixth nerve palsy

An unusual case of bilateral sixth nerve palsy associated with ecstasy has been reported (48). 

A 17-year-old man developed horizontal diplopia in all directions of gaze while using ecstasy tablets every 5-7 days for 2 months. A diagnosis of bilateral sixth nerve palsy was confirmed. Ocular motility returned to... 

Schroeder B, Brieden S. Bilateral sixth nerve palsy associated with MDMA ( ecstasy ) abuse. Am J Ophthalmol 2000 129(3) 408-9. 

Chronic and acute sixth nerve palsy in adults would seem to be a prime indication for the use of botulinum. This application may be especially useful in chronic partial sixth nerve palsies in which there is secondary contracture of the medial rectus muscle with residual function of the lateral rectus muscle. Although advocated by many, the effectiveness of botulinum injected into the ipsilat-eral medial rectus in patients with chronic sixth nerve palsy remains ill-defined. A prospective analysis reported on 6-month success rates in chronic sixth nerve palsy. 

In summary, the mounting evidence supports the use of botulinum toxin in treating various forms of strabismus. These conditions include chronic and acute sixth nerve palsy, infantile esotropia, luidercorrection or overcorrection of strabismus with some residual level of binocularity,... 

Holmes JM, Beck RW, Kip KE, et al. Botulinum toxin treatment versus conservative management in acute traumatic sixth nerve palsy or paresis. JAAPOS 2000 4 145-149. 

Lee J, Harris S, Cohen J, et al. Results of a prospective randomized trial of botulinum toxin therapy in acute unilateral sixth nerve palsy. J Pediatr Ophthalmol Strabismus 1994 31 283-286. 

Repka MX, Lam GC, Morrison NA. The efficacy of bomlinum neurotoxin A for the treatment of complete and partially recovered chronic sixth nerve palsy. J Pediatr Ophthalmol Strabismns 1994 31 79-83. 

Controversial reports of ocular symptoms have been published in patients taking oral ciclosporin, with ptosis and diplopia attributed to unilateral or bilateral sixth nerve palsies in four patients (who had also taken ganciclovir), and nystagmus in one patient (SEDA-21, 383). Peripheral optic neuropathy, with visual loss, nystagmus, and ophthalmoplegia, has also been reported (38). Acute cerebral cortical blindness complicating ciclosporin therapy in a 5-year-old girl (39) and transient cortical blindness and occipital seizures with visual impairment (40,41) have also been reported in association with ciclosporin. 

A variety of other neurological complications have also been recorded. These include Guillain-Barre syndrome, auditory or visual disturbances, motor aphasia, sixth nerve palsy (SEDA-8, 431), mania, organic brain syndrome (SEDA-10,425), confusional changes, and absence status. Absence status responds rapidly to intravenous diazepam (SEDA-14, 415). 

A 13-month-old girl developed a recurrent sixth nerve palsy 1 week after MMR immunization. This resolved completely over 8 weeks and recurred 15 weeks after initial onset. Other causes for the sixth nerve palsy were excluded. 

McCormick A, Dinakaran S, Bhola R, Rennie IG. Recurrent sixth nerve palsy following measles mumps rubella vaccination. Eye 2001 15(Pt 3) 356-7. 

In some cases the central nervous system may have been affected (109,130,131), and cranial nerve palsies have been reported (132). In a survey of ear deformities attributed to thalidomide (133) there were also 19 cases of seventh cranial nerve lesions and 18 cases of sixth nerve lesions (134). 

Lash SC, Williams CP, Marsh CS, Critchley C, Hodgkins PR, Mackie EJ. Acute sixth-nerve palsy after vincristine therapy. J AAPOS 2004 8(l) 67-8. 

Ng EW, Congdon NG, Sommer A. Acute sixth nerve palsy in vitamin A treatment of xerophthalmia. Br J Ophthalmol 2000 84(8) 931-2. 

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