A five year old female had an isolated abducens nerve palsy following
closed head injury, There was no associated skull fracture, haematoma,
or other cranial nerve injury, The significance, frequency, and diffe
rential diagnosis of traumatic sixth cranial nerve injury is discussed
, particularly in paediatric patients, Management is symptomatic; occl
usion with an eye pad may be used if diplopia is significant, In young
children alternate day occlusion of each eye will help prevent amblyo
pia. Most cases improve within three months and many resolve by six mo
nths. Residual palsy at six months is likely to be permanent and surgi
cal treatment may be needed.