شلل العصب المبعِّد الكامل أو الثنائي: الخطوة التالية عند عدم تحقيق العلاج المحافظ راحةً كافيةً من الرؤية المزدوجة أو تصحيحاً للحوَل الداخلي

References

DOI: 10.1016/j.apjo.2026.100297

In complete abducens nerve palsy, there is no function in the lateral rectus, and the eye cannot abduct beyond the midline.

During the acute phase, classification of partial versus complete palsy is primarily based on whether abduction can pass the midline.

Early botulinum toxin injection into the ipsilateral medial rectus (within 1–3 months) may be considered in complete or bilateral abducens nerve palsies, in which spontaneous recovery rates are relatively low.

In complete abducens nerve palsy, vertical rectus transposition is the preferred first-line surgical option.

When performing transposition procedures, weakening of the medial rectus via recession or chemodenervation is generally combined to enhance the corrective effect. In patients at high risk of anterior segment ischemia, botulinum toxin injection may be used as an alternative to medial rectus recession.