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.