Lateral rectus palsy

Alternative names
Abducens palsy; Cranial mononeuropathy VI

Cranial mononeuropathy VI is a disorder that causes double vision, associated with dysfunction of cranial nerve VI, which is responsible for moving the eye to the side.

Causes, incidence, and risk factors

Cranial mononeuropathy VI is a mononeuropathy (damage to a single nerve) involving the sixth cranial (abducens) nerve, one of the cranial nerves that controls eye movement.

Abducens nerve disorders are often associated with diabetic neuropathy, trauma, infections (like meningitis or sinusitis), infarction (tissue damage from loss of blood flow), cranial aneurysms, tumors, or increased intracranial pressure (pressure within the skull). In some cases, no cause can be found.

Because of common pathways through the skull, other cranial nerves (such as the third or fourth cranial nerve) may be affected simultaneously.


Symptoms may include double vision when looking to one side (unilateral injury). In some cases, there is pain or headaches.

Signs and tests

Testing of eye movement shows that one eye has difficulty looking to the side and the other eye moves normally. An eye examination shows the eyes do not align - either at rest, or when looking in the direction of the weak eye.

A complete medical and neurological examination must be done to determine if other parts of the nervous sytem are affected. Depending on the suspected cause, a patient may undergo blood tests, a head imaging study like an MRI or CT scan, and possibly a lumbar puncture (spinal tap).


In some cases, corticosteroids may reduce swelling and relieve pressure on the nerve. In other cases, the condition disappear without treatment. If the cause can be identified, symptoms may be treated and relieved. Close control of blood sugar levels in diabetics may be beneficial.

Until the nerve heals, an eye patch may alleviate double vision.

Expectations (prognosis)
The outcome depends on the underlying cause. Treatment of the underlying cause may improve the condition. Improvement may occur even if the cause is never determined.


Some complications include permanent vision changes.

Calling your health care provider
Call your health care provider if double vision occurs.


No specific prevention is available, although patients with diabetes may reduce the risk by controlling their blood sugar.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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