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Sixth Cranial Nerve (Abducens Nerve) Palsy

By Michael Rubin, MDCM, Weill Cornell Medical College;New York Presbyterian Hospital-Cornell Medical Center

A palsy of the 6th cranial nerve affects the ability to turn the eye outward.

Many disorders can cause this palsy:

  • Head injuries

  • Tumors

  • Multiple sclerosis

  • A bulge (aneurysm) in an artery in the skull

  • Brain infections, such as meningitis, a brain abscess, or a parasitic infection

  • Complications of an ear or eye infection

  • Bleeding within the brain

  • Blockage of an artery supplying the nerve, as can result from diabetes, a stroke, a transient ischemic attack, or vasculitis (inflammation of blood vessels)

  • Wernicke encephalopathy (commonly due to chronic alcoholism)

  • Idiopathic intracranial hypertension (pseudotumor cerebri)

  • Respiratory infections (in children)

Some of these disorders, such as tumors and brain abscesses, increase pressure within the skull and put pressure on (compress) the nerve. Other disorders, such as a blocked artery, interfere with blood flow to the nerve.

If this palsy occurs alone (without other cranial nerve palsies), its cause is often never identified.


The affected eye cannot turn fully outward and may turn inward when people look straight ahead. Double vision occurs when people look toward the side of the affected eye.

Other symptoms depend on the cause. For example, disorders that increase pressure inside the skull may cause a severe headache and temporary blurring of vision when people move their head suddenly. Also, the face and mouth may be numb, and people may be unable to move the affected eye in other directions.


  • Ophthalmoscopy

  • Computed tomography or magnetic resonance imaging

  • Sometimes a spinal tap

  • Sometimes blood tests

Usually, doctors can easily identify a 6th cranial nerve palsy, but the cause is less obvious.

An ophthalmoscope (see Figure: What Is an Ophthalmoscope?) is used to look into the eye and check for evidence of increased pressure within the skull and abnormalities in blood vessels. Computed tomography (CT) or, preferably, magnetic resonance imaging (MRI) of the brain is done to exclude tumors and other abnormalities. If the results are unclear, a spinal tap (lumbar puncture—see Tests for Brain, Spinal Cord, and Nerve Disorders : Spinal Tap) may be done to determine whether pressure within the skull is increased and whether an infection is present.

If symptoms suggest vasculitis, blood is withdrawn to check for evidence of inflammation, such as certain abnormal antibodies (antinuclear antibodies and rheumatoid factor) and an abnormal erythrocyte sedimentation rate (ESR—how quickly red blood cells settle to the bottom of a test tube containing blood). After all tests are done, the cause may remain unknown.


  • Treatment of the cause

Treatment depends on the cause. When the cause is treated, the palsy usually resolves.

Palsies with no identifiable cause usually resolve without treatment within 2 months, as do those due to a blocked blood vessel.

* This is the Consumer Version. *