Sixth Nerve Palsy diagnosed with no cause

Question

Hi,

My husband 36yrs woke up with a distorted,super imposed vision. We took him to ER, the Dr's performed blood test for diabetes, MRI and MRA. All tests came back normal. Blood pressure was also in normal range. We were referred to an Opthamologist who did field test on the eyes and said everthing is normal. Only reason they could relate to is his migraines (which he has now and then).

His left eye when he is moving to the left is stuck in the middle and doesn't move. The opthamologist has told us it is Sixth nerve palsy and would take 3 months to recover. Does patching of the left eye help? How can we do to make the recovery faster? Are there any vision therapy or eye exercises that can be done? When would the vision start to get better. 

What are our options? Any suggestions would be appreciated. Thanks

lmacmanus · Answer

Hello, I am 67y/o female  in pretty good health (low Thyroid  and high cholesterol) still working  when suddenly last year in July 2018 I developed  double vision with my left eye turning inward, no trauma.  I am medical so I knew it wasn't a stroke. Turned out it was 6th cranial nerve palsy. MRI of the head was OK. No treatment so far just seeing an expensive Neuro Ophthalmologist. I wear a patch because altho the eye has started to move I still see double and it is impossible to even walk w/o a patch. I'm not driving because of the decreased depth perception. UGH. Good luck to all the fellow suffers.

Srinishaa · Answer

Hi everyone. ..I would like to share my story on sixth nerve palsy.I am 16 years old and on December 10,2016 I woke up to this horrible sixth nerve palsy.I woke up to see all the things around me double.I was extremely scared as I did not have any idea about what this was.And we ran to the eye hospital and the opthalmologist there suggested us to go to a neurologist and take a mri.The MRI showed normal observations n so the chances of brain tumor were ruled out.Then we went to the neurologist and he told me to take a bunch of blood tests which came out normal.So he concluded that it was idiopathic and would start improving by  the 2nd or 3rd month.These days were the worst days of my life there was not a single day I did not cry.And we visited a lot of other doctors who eventually told me the same thing.They said "There are 80% chances it might recover and rest 20%  is pure luck".The first two months there was no improvement and I decided to go to the ena specialist.Since my MRI showed mild sinusitis in my spenoid region he suggested that could be the reason and put me under treatment with high dose antibiotics intravenously for 14 days.I started noticing improvement from the 4th day of my medication.From that day onwards it improved very slowly and by the end of third month my eyesight was back to normal.i had slight double vision on my extreme left but that was not much disturbance.So this could have improved because of the antibiotic treatment or could have been a natural recovery.No one can tell.My observations were that I had severe cold and cough and slight sinus headaches and drank slush(crushed ice drink) at a party a few days before this problem.Maybe this could have affected my nerves.But I'm really thankful to God that I recovered back to my normal self and now I'm perfectly alright.To all the sufferers out there please don't loose hope many people have recovered from this problem.Take this as a test God kept to test ur tolerance.I know it's a really hard time for u all but everything's gonna be alright.If you have any questions about this problem u can email me at ***@****.

krazi88 · Answer

I have six nerve palsy going now is my 4th year from a sport injury trauma that impacted at the bottom of my right eye, first few weeks was fine til concussions started coming, then one day my eyes started to cross, first year was terrible, can't do nothing but sleep 24 hours of one half of my brain has throbbing headaches. I would wear eye patch and alternate with each eye. doctors won't help, their depression pills only helps a bit because it makes me feel tired and want to sleep. After two years it improves so ever slowly that I can barely tell and i can only sleep with my head on one side because the other side would be too senstive and painful . Just last year I started Accupunture, and let me tell you, i can feel a drastic change as my headaches seemed to be alot less pain once the needles are in my head I feel good, but it will wear off after a day and going once a week actually feels like it speeds up recovery, I wish I can just leave the needles in as I would have less headaches during that moment. my headache area is decreasing into a smaller size of area of my head. I say give Accupunture a try. Trust me, I was so depress the first two years that felt like it's worth a damn no more

Nawlins · Answer

Five weeks ago I woke up with double vision. I had been having headaches for about a week before, and emotionally I felt like something was going to happen. I went to the ER and because I have high blood pressure and diabetes I was immediately admitted to the hospital and the tests began. 

After everything was finished I was diagnosed with sixth nerve palsy. Going on six weeks now, I have no improvement. I was also switched from mediformin to insulin, which by the third week it's been determined that the insulin they put me on was causing me to have excruciating pain. 

I can't drive and can't work.  Has anyone been through this, please tell me what to expect. My doctors are not doing much for me and hard to get appointments. My next appointments are two weeks away.

Very depressed, sad and stir crazy.

Foggy2 · Answer

I'm not sure if you will get a reply since this thread is over a year old.  If you are concerned with your baby, I suggest you have him evaluated by your baby's doctor.

SudhaS85 · Answer

hi Kavya... so its been years... can u tell me if this was resolved and how long it took for him to recover after onset ? I am facing the same problem with my 9 month old baby which we could not digest to see her like that.. plz reply..

balaramya06 · Answer

Hi Kavya,
My husband is having same problem as you mentioned in your post,could you pls tell me,has he recovered from that and what intervention he had?If he fully recovered,how long it had taken?

Kavya25 · Answer

Thanks everyone for taking time to post your comments.Appreciate it so much. He has put a patch on his left eye and switching twice a day to right eye. He has been taking rest for the past week since it occured and we can  see little bit of difference. 

when he is trying to see his left when this happened his left eyeball was stuck in the middle and wouldn't move to the left but today we noticed that he is looking to the left his left eye ball is slightly tilted to the left. Hopefully he will recover soon. We have asked Opthamologist for prisms and she mentioned that it wouldn't help him even with prisms. 

Left a message for Opthamologist regarding  botulinum toxin. Will see what she has to say.Will keep posted.

loimmarmar · Answer

Hello again,
    YES YES YES.......PRISM......I knew it was a simple word....and Thank You Dr for your ability to know just what I was describing....Now for the advice given by you as well as caregiver222, There is great knowledge here and as said the best thing is keep a watch....I did want to clairify one point.....THE eye patch....I went back and re-read what I wrote and I did say about putting it on the GOOD eye, so that you could watch yourself watching your troubled eye in the mirror...Sometimes, if one eye is expected to see because other eye is covered then the brain will attempt to compensate, and that, in and of itself will start the exercise process....You do not do it for long at any one time or to the point of eye or head pain...and yes I did use the patch on the other eye at times....but only to keep from being dizzy as that would come and go with movement...but not always...and I like that I learned about the time frame of wearing the patch and yes it makes perfect sense...Keep us in the know..Have a wonderful Blessed Day!!!!     GOD BLESS!!!!!      loimmarmar

DrSharma · Answer

Hi there. To maintain binocular vision, Fresnel prisms are used. These prisms are attached to the patient’s glasses or to plano glasses if there is no refractive error. Other management options include use of botulinum toxin, injected into same side medial rectus, which helps prevent the contracture of medial rectus. By removing the pull of the medial rectus, it may serve to reveal whether the palsy is partial or complete by allowing any residual movement capability of lateral rectus to operate. The recovery may take 9 to 12 months of wait and watch period after which management will be either conservative or surgical. Consult your ophthalmologist for further advice. Hope this helps. Take care.

caregiver222 · Answer

Yes, a patch over thye affected eye is the usual treatment, however it should not be worn more than 12 hours a day (ballpark). Ocasionally, if vision is entirely cut off, the optic nerve deteriorates.

Basically, there is no other treatment other than watchful waiting.

As you have been informed the condition usually resolves with two to three months, but may return.

loimmarmar · Answer

Hello,
   Welcome, although circumstances for visit I know can be concerning to say the least....Now, I am SSssOOooo glad that you took him right away...So nothing showed on the mri...thats great...no rupture in the brain...blood pressure ck and diabetes  (btw, was it just a blood test or did they do a urine also), Does he have any dizziness when moving body?,head?, eyes?....How many of things does he see at one time....I have had up to 6 of the same things stacked right beside each other...(of course there was only one)....I was told that there were no exercises that could change the position of the eyes once damage was done..,.especially in my case (sub-arakanoid hemmorage...PCA, third nerve at the brain stem),   I NOW BEG TO DIFFER!!!! I sat in my car, sometimes up to 6 or 7 times a day for approx 15 - 20 min at a time for almost 2 months and this is what I did. I would put the patch on the right eye(better eye)...then sit in passenger seat with mirror down...I would watch my eye watching me, and then move it back and forth - left to right - then far left to far right...up and down...look out over to horizon..look up close....The eye is now almost exactly where it was before and I only see 2 or sometimes 3 depending on other health issues and exposures....My eye dr put something on my glasses, although now I forget what it was called....,okay, I'll explain it...You know a pictures that looks like one thing then when you move an inch...the picture changes...that is caused by the plexy glass type of material that has a bunch of BI-focals looking lines on and unevenness to it....it is not smooth and the name still escapes me...(brain freeze), anyway he put one of those on the left lens and that regulated it to from what I did see,  to seeing less of them....not a kalidiscope, not bi focal, I keep wanting to say paralulligram and I know that is not right...I'm going to send this and when I find that word I want I will post seperate....
 ...Things like this can come from the oddest things, viruses, cold type symptoms...has he been out of the country or had any other health issues...I hope you find the answers you seek and the eyesight he needs and both you all want..Please keep us updated....Have a better Blessed Day!!!!     GOD BLESS!!!!    loimmarmar