Abstract
Unresolved VIth nerve palsy that is not adequately controlled by an abnormal head posture or prisms can be very suitably treated by surgery. It is however essential to differentiate partially recovered palsies, which are amenable to horizontal rectus surgery, from unrecovered palsies, which must be treated initially by a vertical muscle transposition procedure. Botulinum toxin is a valuable tool in making this distinction. It also facilitates full tendon transposition in unrecovered palsies, which appears to produce the best functional outcome of all the transposition procedures, with a reduction in the need for further surgery. A study of the surgical management of 12 patients with partially recovered VIth nerve palsy and 59 patients with unrecovered palsy provides clear guidelines on how to attain a successful functional outcome with the minimum amount of surgery.
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Rush JA, Younge BR : Paralysis of cranial nerves III, IV, and VI. Arch Ophthalmol 1981, 99: 76–9.
Fitzsimons R, Lee J, Elston J : The role of botulinum toxin in the management of sixth nerve palsy. Eye 1989, 3: 391–400.
Fells P : The treatment of non-comitant strabismus. Doc Ophthalmol Proc Ser 1982, 32: 197–201.
von Noorden GK : Binocular Vision and Ocular Motility, 4th edition, St. Louis, C.V. Mosby, 1990: 391–3.
Fitzsimons R, Lee JP, Elston J : Treatment of sixth nerve palsy in adults with combined botulinum toxin chemodener-vation and surgery. Ophthalmology 1988, 95: 1535–42.
Rosenbaum AL, Kushner BJ, Kirschen D : Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy. Arch Ophthalmol 1989, 107: 820–3.
McManaway JW, Buckley EG, Brodsky MC : Vertical rectus muscle transposition with intraoperative botulinum injection for treatment of chronic sixth nerve palsy. Graefe's Arch Clin Exp Ophthalmol 1990, 228: 401–6.
Fitzsimons R, White J : Functional scoring of the field of binocular single vision. Ophthalmology 1990, 97: 33–5.
Berens C, Girard LJ : Transplantation of the superior and inferior rectus muscles for paralysis of the lateral rectus. Am J Ophthalmol 1950, 33: 1041–9.
Jensen CDF : Rectus muscle union: a new operation for paralysis of the rectus muscles. Trans Pac Coast Ophthalmol Soc 1964, 45: 359–87.
Selezinka W, Sandall GS, Henderson JW : Rectus muscle union in sixth nerve paralysis. Arch Ophthalmol 1974, 92: 382–6.
Scott WE, Werner DB, Lennarson L : Evaluation of Jensen procedures by saccades and diplopic fields. Arch Ophthalmol 1979, 97: 1886–9.
Rosenbaum AL, Foster RS, Ballard E, Rosales T, Gruenberg P, Choy P : Complete superior and inferior rectus transposition with adjustable medial rectus recession for abducens palsy. In Reinecke RD ed. Strabismus II, Orlando: Grune & Stratton 1984: 599–605.
Lee DA, Dyer JA, O'Brien PC, Taylor JZ : Surgical treatment of lateral rectus muscle paralysis. Am J Ophthalmol 1984: 97: 511–18.
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Riordan-Eva, P., Lee, J. Management of VIth nerve palsy—Avoiding unnecessary surgery. Eye 6, 386–390 (1992). https://doi.org/10.1038/eye.1992.79
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DOI: https://doi.org/10.1038/eye.1992.79