Outcomes of Surgical and Non-Surgical Treatment for Sixth Nerve Palsy

PURPOSE: To report the outcomes of surgical and non-surgical treatment in sixth nerve paresis and palsy. METHODS: This retrospective study was performed on hospital records of 33 consecutive patients (37 eyes) with sixth nerve dysfunction who were referred to Labbafinejad Medical Center from September 1996 to September 2006, and underwent surgical procedures or botulinum toxin injection. Patients were divided into three groups: group A had muscle surgery without transposition, group B underwent transposition procedures and group C received Botulinum toxin injection. RESULTS: Overall, 33 patients including 19 male and 14 female subjects with mean age of 20.4±17.2 years (range, 6 months to 66 years) were studied. Eye deviation improved from 50.3±16.8 to 6.0±9.8 prism diopters (PD) after the first operation and to 2.5±5.0 PD after the second operation in group A, from 56.9±24.3 to 5.5±16.0 PD after the first procedure and to almost zero following the second in group B, and from 44.3±10.5 to 15.0±20.0 PD 6 months following botulinum toxin injection in group C. Head posture and limitation of motility also improved significantly in all three groups. The overall rate of reoperations was 21%. CONCLUSIONS: Various procedures are effective for treatment of sixth nerve dysfunction; all improve ocular deviation, head turn and abduction deficit. The rate of reoperation is not high when treatment is appropriately selected according to clinical condition.