from
the primary position during normal
use. Diplopia occurs in extreme positions of lateral gaze is
tolerated by most patients. Like our patient here with a paretic
left 6th nerve palsy, he may be
comfortable with his eyes in primary position and in
right gaze but he experiences diplopia only in
lt gaze.
A slight head turn toward the left may eliminate the need to move the eye
into that position, in which case therapy obviously is
not required. However, what is easily
tolerated by one patient may not be acceptable
to another.
Indications for therapy are the
presence of diplopia in the practical field of fixation
and inability to maintain
single binocular vision without a conspicuous
anomalous head posture.
In desperate situations in which
single binocular vision cannot possibly be restored
by any means, occlusion of one eye,
preferably the sound eye, is a last resort to create
visual comfort for the patient.
Several methods have been advocated
to prevent secondary contracture of the
antagonist of a paretic muscle in lateral rectus
paralysis . The antagonistic muscle ( MR ) could be
injected with botulinum toxin .
Examination of the patient after 6 months of the
onset of head injury will reveal the extent to which
the lateral rectus muscle may recover ( partial or
full recovery ) , according to the finding data at
that time , the surgical plan - if needed - could be
done.
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