Predictors of nonrecovery in acute traumatic sixth nerve palsy and paresis

Purpose: To evaluate whether nonrecovery from acute traumatic sixth nerve p alsy could be predicted from demographic factors or palsy characteristics. Design: Prospective, observational case series. Setting. Multicenter (academic and private practices). Outcome Measure: Nonrecovery, defined as the presence of diplopia in primar y position or more than 10 prism diopters of distance esotropia in primary position at 6 months after onset. Methods: Using data from a previously described cohort of 84 eligible patie nts with acute traumatic sixth nerve palsy, we performed multivariate analy ses of demographic factors and palsy characteristics. Results: Nonrecovery at 6 months after onset was associated with a complete palsy (adjusted risk ratio, 9.11; 95% confidence interval [CI], 2.77-14.84 ) and with a bilateral palsy or paresis (adjusted risk ratio, 2.53; 95% Cl, 0.98-4.29). The choice of conservative management (observation, prism, or patch) versus acute injection of Botulinum toxin (within 3 months of injury ) did not influence final recovery. Conclusions: In acute traumatic sixth nerve palsy or paresis, failure to re cover by 6 months after onset was associated independently with inability t o abduct past midline at presentation and bilaterality. Although the overal l recovery rate is high in acute traumatic sixth nerve palsy or paresis, a complete or bilateral case has a poor prognosis and is more likely to need strabismus surgery. Ophthalmology 2001;108:1457-1460 (C) 2001 by the Americ an Academy of Ophthalmology.