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Isolated 6th Nerve Palsy – Young Adult — SCE Neurology MCQ

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HardNeuro-ophthalmologyIsolated 6th Nerve Palsy – Young AdultSCE Neurology

A 62-year-old man with hypertension develops an isolated left sixth-nerve palsy. MRI and vascular imaging show no structural lesion, and there are no features of raised intracranial pressure or giant-cell arteritis. At 6 weeks the deviation is measurably improving, but he wants binocular single vision for straight-ahead tasks. Which intervention best fits this phase?

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Correct answer: D — A Fresnel prism adjusted as the ocular deviation changes

An improving isolated sixth-nerve palsy with reassuring investigation is usually managed symptomatically while recovery evolves. A Fresnel prism can restore binocular single vision in the required gaze and can be changed as the deviation improves. A ground-in prism is poorly suited to a changing angle, while monocular occlusion controls diplopia by sacrificing binocular vision and therefore does not match the stated goal. Botulinum toxin is not routine at this improving stage, and definitive strabismus surgery is generally deferred until persistent non-recovery and stability, commonly around 12 months.

Reference: University Hospitals Sussex NHS Foundation Trust, Sixth (VI) nerve palsy: https://www.uhsussex.nhs.uk/resources/sixth-vi-nerve-palsy/