Treatment of Abducens Nerve Palsy in Partial Paresis with Residual Lateral Rectus Function
This protocol addresses acute abducens nerve palsy presenting as a partial palsy (paresis) — where residual lateral rectus function is preserved and abduction can pass beyond the midline, distinguishing it from complete palsy.
An acute abducens palsy typically presents with esotropia and an abduction deficit. Partial palsy is classified on the basis that abduction can cross the midline, indicating preserved lateral rectus function. This distinction is the key criterion that defines this sub-population and guides subsequent management.
Addressing the underlying cause takes priority; during the acute phase, management focuses on occlusion-based interventions to relieve diplopia.
The primary goals are relief of diplopia and spontaneous recovery of the palsy — resolution of esotropia and the abduction deficit — typically expected within 3–6 months.
References
DOI: 10.1016/j.apjo.2026.100297- An acute palsy classically presents with esotropia and abduction deficiency, ranging from partial palsy (paresis) to complete palsy (inability to move beyond the midline).
- During the acute phase, classification of partial versus complete palsy is primarily based on whether abduction can pass the midline.
- The first priority is always to treat the underlying causes.
- During the acute phase, patching, opaque lenses, or prisms are recommended to relieve diplopia.
- Spontaneous recovery rates vary from 31% to 87%, with higher rates observed in patients with microvascular ischemia or trauma, typically within 3–6 months.