481:
actions: firstly, an overaction of the medial rectus of the affected eye, then an overaction of the medial rectus of the contraletral eye and, finally, an underaction of the lateral rectus of the unaffected eye - something known as an inhibitional palsy. These changes serve to reduce the variation in the misalignment of the two eyes in different gaze positions (incomitance). Where this process has fully developed, the preferred option is a simple recession, or weakening, of the medial rectus of the affected eye, combined with a resection, or strengthening, of the lateral rectus of the same eye. However, where the inhibitional palsy of the contralateral lateral rectus has not developed, there will still be gross incomitance, with the disparity between the eye positions being markedly greater in the field of action of the affected muscle. In such cases recession of the medial rectus of the affected eye is accompanied by recession and/or posterior fixation (Fadenoperation) of the contraleral medial rectus.
433:. These slim flexible plastic prisms can be attached to the patient's glasses, or to plano glasses if the patient has no refractive error, and serve to compensate for the inward misalignment of the affected eye. Unfortunately, the prism only correct for a fixed degree of misalignment and, because the affected individual's degree of misalignment will vary depending upon their direction of gaze, they may still experience diplopia when looking to the affected side. The prisms are available in different strengths and the most appropriate one can be selected for each patient. However, in patients with large deviations, the thickness of the prism required may reduce vision so much that binocularity is not achievable. In such cases it may be more appropriate simply to occlude one eye temporarily. Occlusion would never be used in infants though both because of the risk of inducing stimulus deprivation
452:). The use of BT serves a number of purposes. Firstly, it helps to prevent the contracture of the medial rectus which might result from its acting unopposed for a long period. Secondly, by reducing the size of the deviation temporarily it might allow prismatic correction to be used where this was not previously possible, and, thirdly, by removing the pull of the medial rectus it may serve to reveal whether the palsy is partial or complete by allowing any residual movement capability of the lateral rectus to operate. Thus, the toxin works both therapeutically, by helping to reduce symptoms and enhancing the prospects for fuller ocular movements post-operatively, and diagnostically, by helping to determine the type of operation most appropriate for each patient.
477:
using the functioning inferior and superior recti to gain some degree of abduction. An alternative approach is to operate on both the lateral and medial recti of the affected eye, with the aim of stabilising it at the midline, thus giving single vision straight ahead but potentially diplopia on both far left and right gaze. This procedure is often most appropriate for those with total paralysis who, because of other health problems, are at increased risk of the anterior segment ischaemia associated with complex multi-muscle transposition procedures.
135:, a convergent squint on distance fixation. On near fixation the affected individual may have only a latent deviation and be able to maintain binocularity or have an esotropia of a smaller size. Patients sometimes adopt a face turned towards the side of the affected eye, moving the eye away from the field of action of the affected lateral rectus muscle, with the aim of controlling diplopia and maintaining binocular vision.
104:(commonly known as double vision) in which the two images appear side-by-side. Thus, the diplopia is horizontal and worse in the distance. Diplopia is also increased on looking to the affected side and is partly caused by overaction of the medial rectus on the unaffected side as it tries to provide the extra innervation to the affected lateral rectus. These two muscles are
40:
467:
If the residual esotropia is small, or if the patient is unfit or unwilling to have surgery, prisms can be incorporated into their glasses to provide more permanent symptom relief. When the deviation is too large for prismatic correction to be effective, permanent occlusion may be the only option for
271:
The pathophysiological mechanism of sixth nerve palsy with increased intracranial pressure has traditionally been said to be stretching of the nerve in its long intracranial course, or compression against the petrous ligament or the ridge of the petrous temporal bone. Collier, however, was "unable to
476:
The procedure chosen will depend upon the degree to which any function remains in the affected lateral rectus. Where there is complete paralysis, the preferred option is to perform vertical muscle transposition procedures such as Jensen's, Hummelheim's or whole muscle transposition, with the aim of
455:
A Cochrane Review on interventions for eye movement disorders due to acquired brain injury, last updated June 2017, identified one study of botulinum toxin for acute sixth nerve palsy. The
Cochrane review authors judged this to be low-certainty evidence; the study was not masked and the estimate of
284:
pass through the nucleus to the opposite IIIrd nerve nucleus. Thus, a nuclear lesion will give rise to an ipsilateral gaze palsy. In addition, fibers of the seventh cranial nerve wrap around the VIth nerve nucleus, and, if this is also affected, a VIth nerve palsy with ipsilateral facial palsy will
363:
Differential diagnosis is rarely difficult in adults. Onset is typically sudden with symptoms of horizontal diplopia. Limitations of eye movements are confined to abduction of the affected eye (or abduction of both eyes if bilateral) and the size of the resulting convergent squint or esotropia is
272:
accept this explanation", his view being that since the sixth nerve emerges straight forward from the brain stem, whereas other cranial nerves emerge obliquely or transversely, it is more liable to the mechanical effects of backward brain stem displacement by intracranial space occupying lesions.
149:
present in childhood allows the child to 'switch off' the information coming from one eye (in this case the esotropic eye), thus relieving any diplopic symptoms. Whilst this is a positive adaptation in the short term, in the long term it can lead to a lack of appropriate development of the visual
480:
Where some function remains in the affected eye, the preferred procedure depends upon the degree of development of muscle sequelae. In a sixth nerve palsy one would expect that, over the 6 month observation period, most patients would show the following pattern of changes to their ocular muscle
364:
always larger on distance fixation - where the lateral recti are more active - than on near fixation - where the medial recti are dominant. Abduction limitations that mimic VIth nerve palsy may result secondary to surgery, to trauma or as a result of other conditions such as
404:
4. Iatrogenic injury. Abducens nerve palsy is also known to occur with halo orthosis placement. The resultant palsy is identified through loss of lateral gaze after application of the orthosis and is the most common cranial nerve injury associated with this device.
342:. In addition, III, IV, V1, and V2 involvement might also indicate a sinus lesion as all run toward the orbit in the sinus wall. Lesions in this area can arise as a result of vascular problems, inflammation, metastatic carcinomas and primary meningiomas.
329:. This condition results in a VIth nerve palsy with an associated reduction in hearing ipsilaterally, plus facial pain and paralysis, and photophobia. Similar symptoms can also occur secondary to petrous fractures or to nasopharyngeal tumours.
375:
In children, differential diagnosis is more difficult because of the problems inherent in getting infants to cooperate with a full eye movement investigation. Possible alternative diagnosis for an abduction deficit would include:
538:
2700:
1070:
1055:
337:
The nerve runs in the sinus body adjacent to the internal carotid artery and oculo-sympathetic fibres responsible for pupil control, thus, lesions here might be associated with pupillary dysfunctions such as
413:
The first aims of management should be to identify and treat the cause of the condition, where this is possible, and to relieve the patient's symptoms, where present. In children, who rarely appreciate
464:
If adequate recovery has not occurred after the 6-month period (during which observation, prism management, occlusion, or botulinum toxin may be considered), surgical treatment is often recommended.
350:
The VIth nerve's course is short and lesions in the orbit rarely give rise to isolated VIth nerve palsies, but more typically involve one or more of the other extraocular muscle groups.
390:- A condition in which both abduction and adduction are affected arising as a result of partial innervation of the lateral rectus by branches from the IIIrd oculomotor cranial nerve.
120:
831:
Lee J, Harris S, Cohen J, Cooper K, MacEwen C, Jones S (1994). "Results of a prospective randomized trial of botulinum toxin therapy in acute unilateral sixth nerve palsy".
398:
263:). Vallee et al. report that benign and rapidly recovering isolated VIth nerve palsy can occur in childhood, sometimes precipitated by ear, nose and throat infections.
170:. Different presentations of the condition, or associations with other conditions, can help to localize the site of the lesion along the VIth cranial nerve pathway.
421:
Thereafter, a period of observation of around 6 months is appropriate before any further intervention, as some palsies will recover without the need for surgery.
730:
Gubler AM (1856). "De l'hémiplégie alterne envisagée comme signe de lésion de la protubérance annulaire et comme preuve de la décussation des nerfs faciaux".
909:
Britt MT, Velez FG, Thacker N, Alcorn D, Foster RS, Rosenbaum AL (October 2003). "Partial rectus muscle-augmented transpositions in abduction deficiency".
289:, a unilateral softening of the brain tissue arising from obstruction of the blood vessels of the pons involving sixth and seventh cranial nerves and the
309:
it lies adjacent to anterior inferior and posterior inferior cerebellar and basilar arteries and is therefore vulnerable to compression against the
2150:
108:
or "yoke muscles" as both attempt to move the eye over to the left or right. The condition is commonly unilateral but can also occur bilaterally.
616:
Harley RD (January 1980). "Paralytic strabismus in children. Etiologic incidence and management of the third, fourth, and sixth nerve palsies".
1547:
383:- a rare congenital disorder in which both VIth and VIIth nerves are bilaterally affected giving rise to a typically 'expressionless' face.
2219:
2145:
280:
Isolated lesions of the VI nerve nucleus will not give rise to an isolated VIth nerve palsy because paramedian pontine reticular formation
105:
944:
Neugebauer A, Fricke J, Kirsch A, RĂĽssmann W (March 2001). "Modified transposition procedure of the vertical recti in sixth nerve palsy".
866:
Bansal S, Khan J, Marsh IB (December 2006). "Unaugmented vertical muscle transposition surgery for chronic sixth nerve paralysis".
1159:
782:
Rowe FJ, Hanna K, Evans JR, Noonan CP, Garcia-Finana M, Dodridge CS, et al. (Cochrane Eyes and Vision Group) (March 2018).
2167:
2162:
1987:
1022:
744:
The
Classical Brain Stem Syndromes (translations of the original papers with notes on the evolution of clinical Neuroanatomy)
449:
141:
is typically experienced by adults with VI nerve palsies, but children with the condition may not experience diplopia due to
2027:
2140:
997:
2135:
2022:
1589:
1890:
1750:
313:. Typically palsies caused in this way will be associated with signs and symptoms of headache and/or a rise in ICP.
1855:
2430:
1948:
1860:
1850:
1579:
1943:
1834:
1700:
493:
2341:
2032:
2017:
127:
of the right eye. This individual tries to look to his right, but the right eye fails to turn to the side.
1229:
1187:
1152:
286:
2157:
1953:
1927:
1885:
1880:
1745:
1618:
1606:
1562:
757:
2336:
2224:
2130:
1977:
1822:
1623:
1569:
513:
1875:
1846:
1470:
1435:
1085:
293:
tract, the VIth nerve palsy and ipsilateral facial paresis occur with a contralateral hemiparesis.
111:
The unilateral abducens nerve palsy is the most common of the isolated ocular motor nerve palsies.
2705:
2346:
2100:
1900:
1420:
1413:
326:
297:
can also arise as a result of brainstem lesions which affect Vth, VIth and VIIth cranial nerves.
124:
85:
2615:
2585:
2520:
2515:
2242:
1520:
1385:
1145:
984:
2558:
2234:
418:, the aim will be to maintain binocular vision and, thus, promote proper visual development.
294:
201:
167:
93:
81:
2202:
514:"Sixth nerve palsy | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program"
2331:
1917:
1912:
1870:
1685:
1601:
339:
205:
8:
2636:
2510:
2310:
2193:
2185:
1973:
1937:
1922:
1777:
1557:
1337:
1074:
394:
369:
2266:
150:
cortex giving rise to permanent visual loss in the suppressed eye; a condition known as
2247:
1997:
1905:
1829:
1782:
1594:
1530:
1515:
1375:
1324:
1079:
891:
808:
783:
707:
682:
593:
576:
306:
260:
243:(usually not isolated), Chiari Malformation, hydrocephalus, intracranial hypertension,
224:
1015:
The Wills Eye Manual: Office and
Emergency Room Diagnosis and Treatment of Eye Disease
957:
922:
629:
47:
Figure showing the mode of innervation of the Recti medialis and lateralis of the eye.
2590:
2487:
2112:
1895:
1552:
1458:
1096:
1018:
961:
926:
883:
848:
813:
712:
660:
633:
598:
365:
142:
52:
895:
2378:
2368:
2214:
2189:
2122:
2088:
2007:
1638:
1628:
1525:
1380:
1267:
1257:
953:
918:
875:
840:
803:
799:
795:
702:
694:
625:
588:
310:
1125:
844:
2445:
2409:
2373:
1992:
1817:
1804:
1738:
1695:
1613:
1425:
1357:
1277:
1262:
1090:
539:"I looked down, saw two left hands and four feet, closed one eye and keeled over"
445:
380:
236:
190:
186:
146:
484:
The same approaches are adopted bilaterally where both eyes have been affected.
2675:
2527:
2472:
2315:
2083:
2012:
1794:
1764:
1710:
1664:
1535:
1408:
1342:
1332:
387:
77:
1101:
1064:
1005:
879:
2701:
Disorders of ocular muscles, binocular movement, accommodation and refraction
2694:
2595:
2450:
2390:
2107:
2055:
2002:
1932:
1841:
1728:
1705:
1633:
1542:
1347:
1252:
290:
73:
1137:
557:
2460:
2288:
1669:
1584:
1492:
1370:
1365:
1310:
1305:
965:
930:
887:
817:
716:
602:
430:
244:
213:
182:
852:
698:
664:
637:
2659:
2610:
2553:
2548:
2505:
2483:
2394:
2385:
2305:
2283:
2095:
2067:
1865:
1733:
1574:
1395:
1272:
1224:
1171:
322:
228:
2580:
2543:
2467:
2455:
2399:
2360:
2181:
2071:
1430:
1295:
784:"Interventions for eye movement disorders due to acquired brain injury"
256:
252:
232:
220:
209:
194:
1047:
16:
Inability to turn out the eye due to dysfunction of the abducens nerve
2631:
2605:
2479:
2425:
2413:
2298:
2293:
2278:
2274:
1812:
1510:
1487:
1300:
1247:
1242:
1219:
1120:
434:
424:
151:
132:
97:
89:
57:
321:
The nerve passes adjacent to the mastoid sinus and is vulnerable to
33:
Lateral rectus palsy, VIth cranial nerve palsy, abducens nerve palsy
2670:
2435:
1969:
1772:
1403:
438:
415:
216:
178:
166:, it is often the first nerve compressed when there is any rise in
138:
101:
444:
Other management options at this initial stage include the use of
325:, leading to inflammation of the meninges, which can give rise to
2497:
2440:
1982:
1789:
1720:
1690:
1680:
1287:
119:
2600:
1502:
1479:
1199:
1059:
240:
943:
2572:
281:
163:
651:
Vallée L, Guilbert F, Lemaitre JF, Nuyts JP (May 1990). "".
259:. Sixth nerve palsy causes the eyes to deviate inward (see:
1652:
1214:
650:
332:
173:
The most common causes of VIth nerve palsy in adults are:
39:
251:
In children, Harley reports typical causes as traumatic,
448:, which is injected into the ipsilateral medial rectus (
92:. The inability of an eye to turn outward, results in a
908:
80:), which is responsible for causing contraction of the
995:
758:"Halo Orthosis Immobilization - Spine - Orthobullets"
1037:
830:
781:
393:
3. Cross fixation which develops in the presence of
2201:
401:and results in habitual weakness of lateral recti.
687:Journal of Neurology, Neurosurgery, and Psychiatry
429:This is most commonly achieved through the use of
425:Symptom relief and/or binocular vision maintenance
2146:arteritic anterior (AAION or arteritic AION)
833:Journal of Pediatric Ophthalmology and Strabismus
162:Because the nerve emerges near the bottom of the
2692:
732:Gazette Hebdomadaire de MĂ©decine et de Chirurgie
865:
72:, is a disorder associated with dysfunction of
1012:
676:
674:
1167:
1153:
574:
255:(most commonly brainstem glioma), as well as
2220:Chronic progressive external ophthalmoplegia
996:Sowka JW, Gurwood AS, Kabat AG (2000–2001).
1548:Thygeson's superficial punctate keratopathy
1207:
788:The Cochrane Database of Systematic Reviews
671:
1160:
1146:
468:those unfit or unwilling to have surgery.
38:
1004:. Jobson Publishing L.L.C. Archived from
807:
706:
592:
555:
459:
358:
549:
333:Cavernous sinus/Superior orbital fissure
118:
536:
2693:
746:. Springfield, Illinois: C. C. Thomas.
729:
680:
615:
2657:
2053:
1456:
1185:
1141:
1002:Handbook of Ocular Disease Management
577:"Central nervous system tuberculosis"
450:botulinum toxin therapy of strabismus
305:As the VIth nerve passes through the
300:
114:
2028:Familial exudative vitreoretinopathy
741:
2151:non-arteritic anterior (NAION)
1988:Leber's hereditary optic neuropathy
738:. Paris: 749–754, 789–792, 811–816.
575:Cherian A, Thomas SV (March 2011).
437:and because they do not experience
13:
2023:Persistent tunica vasculosa lentis
976:
266:
14:
2717:
1751:Polypoidal choroidal vasculopathy
1033:
989:Medline Plus Medical Encyclopedia
946:American Journal of Ophthalmology
1856:Central retinal artery occlusion
100:of which the primary symptom is
1861:Branch retinal artery occlusion
1590:Terrien's marginal degeneration
937:
902:
859:
824:
775:
556:Ehrenhaus MP (9 October 2003).
316:
2658:
1891:Bietti's crystalline dystrophy
1851:Central retinal vein occlusion
1580:Pellucid marginal degeneration
800:10.1002/14651858.CD011290.pub2
750:
723:
644:
609:
568:
530:
506:
131:The nerve dysfunction induces
1:
1944:Vitelliform macular dystrophy
1835:Posterior vitreous detachment
1701:Persistent pupillary membrane
1013:Rhee MD DJ, Pyfer MF (1994).
958:10.1016/S0002-9394(00)00805-9
923:10.1016/S1091-8531(03)00180-0
845:10.3928/0191-3913-19940901-03
630:10.1016/S0161-6420(80)35280-9
537:Sellers FS (8 October 2017).
499:
494:Congenital fourth nerve palsy
408:
261:Pathophysiology of strabismus
208:, cavernous sinus mass (e.g.
2431:Leber's congenital amaurosis
2342:Internuclear ophthalmoplegia
2054:
2033:Vogt-Koyanagi-Harada disease
2018:Persistent fetal vasculature
1949:Leber's congenital amaurosis
353:
275:
177:More common: Vasculopathic (
7:
1230:Meibomian gland dysfunction
985:"Cranial Mononeuropathy VI"
487:
399:nystagmus blockage syndrome
10:
2722:
1954:Birdshot chorioretinopathy
1928:Central serous retinopathy
1746:Focal choroidal excavation
1619:Corneal neovascularization
1436:Subconjunctival hemorrhage
1186:
471:
2666:
2653:
2624:
2571:
2536:
2496:
2421:
2408:
2359:
2337:Convergence insufficiency
2324:
2265:
2233:
2210:
2180:
2121:
2079:
2066:
2062:
2049:
1978:Primary juvenile glaucoma
1962:
1823:Cytomegalovirus retinitis
1803:
1763:
1719:
1660:
1651:
1501:
1478:
1469:
1465:
1457:
1452:
1394:
1356:
1323:
1286:
1238:
1198:
1194:
1181:
1172:Diseases of the human eye
1111:
1041:
880:10.1080/09273970601026201
740:; English translation in
518:rarediseases.info.nih.gov
51:
46:
37:
29:
24:
1847:Ocular ischemic syndrome
998:"Cranial Nerve VI Palsy"
683:"False localising signs"
681:Larner AJ (April 2003).
345:
157:
2347:One and a half syndrome
2101:Foster Kennedy syndrome
581:African Health Sciences
287:Millard–Gubler syndrome
200:Less common: Increased
2586:Argyll Robertson pupil
1386:Periorbital cellulitis
558:"Abducens Nerve Palsy"
460:Longer term management
456:effect was imprecise.
359:Differential diagnoses
128:
2559:Scintillating scotoma
2225:Kearns–Sayre syndrome
2168:Toxic and nutritional
2141:posterior (PION)
1624:Kayser–Fleischer ring
742:Wolf JK, ed. (1971).
699:10.1136/jnnp.74.4.415
202:intracranial pressure
168:intracranial pressure
152:amblyopia or Lazy eye
122:
94:convergent strabismus
88:(i.e., turn out) the
82:lateral rectus muscle
2332:Conjugate gaze palsy
2203:Paralytic strabismus
2136:anterior (AION)
1918:Retinitis pigmentosa
1913:Macular degeneration
1686:Intermediate uveitis
1602:Keratoconjunctivitis
762:www.orthobullets.com
653:Annales de PĂ©diatrie
327:Gradenigo's syndrome
206:giant cell arteritis
70:abducens nerve palsy
2637:Childhood blindness
2616:Parinaud's syndrome
2186:Extraocular muscles
1974:Ocular hypertension
1938:Epiretinal membrane
1923:Retinal haemorrhage
1778:Congenital cataract
1017:. J.B. Lippincott.
395:infantile esotropia
370:thyroid eye disease
235:, postmyelography,
2163:Leber's hereditary
1830:Retinal detachment
1783:Childhood cataract
1595:Post-LASIK ectasia
1376:Orbital cellulitis
1325:Lacrimal apparatus
1112:External resources
307:subarachnoid space
301:Subarachnoid space
295:Foville's syndrome
225:multiple sclerosis
129:
115:Signs and symptoms
2688:
2687:
2684:
2683:
2649:
2648:
2645:
2644:
2591:Marcus Gunn pupil
2567:
2566:
2488:Visual impairment
2355:
2354:
2261:
2260:
2248:Fourth-nerve (IV)
2176:
2175:
2113:Optic disc drusen
2045:
2044:
2041:
2040:
1759:
1758:
1647:
1646:
1553:Corneal dystrophy
1448:
1447:
1444:
1443:
1319:
1318:
1135:
1134:
1024:978-0-7817-1602-4
366:myasthenia gravis
340:Horner's syndrome
66:Sixth nerve palsy
63:
62:
25:Sixth nerve palsy
19:Medical condition
2713:
2655:
2654:
2419:
2418:
2410:Vision disorders
2369:Refractive error
2311:Brown's syndrome
2267:Other strabismus
2253:Sixth-nerve (VI)
2243:Oculomotor (III)
2215:Ophthalmoparesis
2208:
2207:
2199:
2198:
2190:Binocular vision
2123:Optic neuropathy
2089:optic papillitis
2077:
2076:
2064:
2063:
2051:
2050:
1940:(Macular pucker)
1658:
1657:
1639:Band keratopathy
1476:
1475:
1467:
1466:
1454:
1453:
1381:Orbital lymphoma
1268:Blepharophimosis
1258:Blepharochalasis
1205:
1204:
1196:
1195:
1183:
1182:
1162:
1155:
1148:
1139:
1138:
1039:
1038:
1028:
1009:
992:
970:
969:
941:
935:
934:
911:Journal of AAPOS
906:
900:
899:
863:
857:
856:
828:
822:
821:
811:
779:
773:
772:
770:
768:
754:
748:
747:
739:
727:
721:
720:
710:
678:
669:
668:
648:
642:
641:
613:
607:
606:
596:
572:
566:
565:
553:
547:
546:
534:
528:
527:
525:
524:
510:
42:
22:
21:
2721:
2720:
2716:
2715:
2714:
2712:
2711:
2710:
2691:
2690:
2689:
2680:
2662:
2641:
2620:
2563:
2532:
2492:
2446:Color blindness
2412:
2404:
2351:
2325:Other binocular
2320:
2257:
2229:
2192:
2188:
2184:
2172:
2117:
2070:
2058:
2037:
1993:Ocular hypotony
1958:
1818:Chorioretinitis
1799:
1755:
1739:Chorioretinitis
1715:
1696:Rubeosis iridis
1674:
1643:
1614:Corneal opacity
1570:Corneal ectasia
1497:
1461:
1440:
1426:Pseudopterygium
1390:
1352:
1315:
1282:
1278:Ankyloblepharon
1234:
1190:
1177:
1176:
1166:
1136:
1131:
1130:
1107:
1106:
1050:
1036:
1031:
1025:
983:
979:
977:Further reading
974:
973:
942:
938:
907:
903:
864:
860:
829:
825:
794:(3): CD011290.
780:
776:
766:
764:
756:
755:
751:
728:
724:
679:
672:
649:
645:
614:
610:
573:
569:
554:
550:
543:Washington Post
535:
531:
522:
520:
512:
511:
507:
502:
490:
474:
462:
446:botulinum toxin
427:
411:
381:Mobius syndrome
361:
356:
348:
335:
319:
303:
278:
269:
267:Pathophysiology
237:lumbar puncture
187:atherosclerosis
160:
147:neuroplasticity
117:
20:
17:
12:
11:
5:
2719:
2709:
2708:
2706:Abducens nerve
2703:
2686:
2685:
2682:
2681:
2679:
2678:
2676:Onchocerciasis
2673:
2667:
2664:
2663:
2651:
2650:
2647:
2646:
2643:
2642:
2640:
2639:
2634:
2628:
2626:
2622:
2621:
2619:
2618:
2613:
2608:
2603:
2598:
2593:
2588:
2583:
2577:
2575:
2569:
2568:
2565:
2564:
2562:
2561:
2556:
2551:
2546:
2540:
2538:
2534:
2533:
2531:
2530:
2528:Quadrantanopia
2525:
2524:
2523:
2518:
2513:
2502:
2500:
2494:
2493:
2491:
2490:
2477:
2476:
2475:
2473:Oguchi disease
2465:
2464:
2463:
2458:
2453:
2443:
2438:
2433:
2428:
2422:
2416:
2406:
2405:
2403:
2402:
2397:
2388:
2383:
2382:
2381:
2376:
2365:
2363:
2357:
2356:
2353:
2352:
2350:
2349:
2344:
2339:
2334:
2328:
2326:
2322:
2321:
2319:
2318:
2316:Duane syndrome
2313:
2308:
2303:
2302:
2301:
2296:
2286:
2281:
2271:
2269:
2263:
2262:
2259:
2258:
2256:
2255:
2250:
2245:
2239:
2237:
2231:
2230:
2228:
2227:
2222:
2217:
2211:
2205:
2196:
2178:
2177:
2174:
2173:
2171:
2170:
2165:
2160:
2155:
2154:
2153:
2148:
2143:
2138:
2127:
2125:
2119:
2118:
2116:
2115:
2110:
2105:
2104:
2103:
2093:
2092:
2091:
2084:Optic neuritis
2080:
2074:
2060:
2059:
2047:
2046:
2043:
2042:
2039:
2038:
2036:
2035:
2030:
2025:
2020:
2015:
2013:Phthisis bulbi
2010:
2005:
2000:
1995:
1990:
1985:
1980:
1966:
1964:
1960:
1959:
1957:
1956:
1951:
1946:
1941:
1935:
1930:
1925:
1920:
1915:
1910:
1909:
1908:
1903:
1898:
1896:Coats' disease
1893:
1888:
1886:of prematurity
1883:
1878:
1873:
1863:
1858:
1853:
1844:
1839:
1838:
1837:
1827:
1826:
1825:
1820:
1809:
1807:
1801:
1800:
1798:
1797:
1795:Ectopia lentis
1792:
1787:
1786:
1785:
1780:
1769:
1767:
1761:
1760:
1757:
1756:
1754:
1753:
1748:
1743:
1742:
1741:
1731:
1725:
1723:
1717:
1716:
1714:
1713:
1708:
1703:
1698:
1693:
1688:
1683:
1677:
1675:
1673:
1672:
1667:
1661:
1655:
1653:Vascular tunic
1649:
1648:
1645:
1644:
1642:
1641:
1636:
1631:
1626:
1621:
1616:
1611:
1610:
1609:
1599:
1598:
1597:
1592:
1587:
1582:
1577:
1567:
1566:
1565:
1560:
1550:
1545:
1540:
1539:
1538:
1536:Photokeratitis
1533:
1528:
1523:
1518:
1507:
1505:
1499:
1498:
1496:
1495:
1490:
1484:
1482:
1473:
1463:
1462:
1450:
1449:
1446:
1445:
1442:
1441:
1439:
1438:
1433:
1428:
1423:
1418:
1417:
1416:
1409:Conjunctivitis
1406:
1400:
1398:
1392:
1391:
1389:
1388:
1383:
1378:
1373:
1368:
1362:
1360:
1354:
1353:
1351:
1350:
1345:
1343:Dacryocystitis
1340:
1335:
1333:Dacryoadenitis
1329:
1327:
1321:
1320:
1317:
1316:
1314:
1313:
1308:
1303:
1298:
1292:
1290:
1284:
1283:
1281:
1280:
1275:
1270:
1265:
1260:
1255:
1250:
1245:
1239:
1236:
1235:
1233:
1232:
1227:
1222:
1217:
1211:
1209:
1202:
1192:
1191:
1179:
1178:
1175:
1174:
1168:
1165:
1164:
1157:
1150:
1142:
1133:
1132:
1129:
1128:
1116:
1115:
1113:
1109:
1108:
1105:
1104:
1093:
1082:
1067:
1051:
1046:
1045:
1043:
1042:Classification
1035:
1034:External links
1032:
1030:
1029:
1023:
1010:
1008:on 2005-11-27.
993:
980:
978:
975:
972:
971:
936:
901:
858:
823:
774:
749:
722:
670:
643:
608:
567:
548:
529:
504:
503:
501:
498:
497:
496:
489:
486:
473:
470:
461:
458:
431:Fresnel prisms
426:
423:
410:
407:
388:Duane syndrome
360:
357:
355:
352:
347:
344:
334:
331:
318:
315:
302:
299:
277:
274:
268:
265:
249:
248:
198:
159:
156:
123:Limitation of
116:
113:
78:abducens nerve
61:
60:
55:
49:
48:
44:
43:
35:
34:
31:
27:
26:
18:
15:
9:
6:
4:
3:
2:
2718:
2707:
2704:
2702:
2699:
2698:
2696:
2677:
2674:
2672:
2669:
2668:
2665:
2661:
2656:
2652:
2638:
2635:
2633:
2630:
2629:
2627:
2623:
2617:
2614:
2612:
2609:
2607:
2604:
2602:
2599:
2597:
2596:Adie syndrome
2594:
2592:
2589:
2587:
2584:
2582:
2579:
2578:
2576:
2574:
2570:
2560:
2557:
2555:
2552:
2550:
2547:
2545:
2542:
2541:
2539:
2535:
2529:
2526:
2522:
2519:
2517:
2514:
2512:
2509:
2508:
2507:
2504:
2503:
2501:
2499:
2495:
2489:
2485:
2481:
2478:
2474:
2471:
2470:
2469:
2466:
2462:
2459:
2457:
2454:
2452:
2451:Achromatopsia
2449:
2448:
2447:
2444:
2442:
2439:
2437:
2434:
2432:
2429:
2427:
2424:
2423:
2420:
2417:
2415:
2411:
2407:
2401:
2398:
2396:
2392:
2391:Anisometropia
2389:
2387:
2384:
2380:
2377:
2375:
2372:
2371:
2370:
2367:
2366:
2364:
2362:
2358:
2348:
2345:
2343:
2340:
2338:
2335:
2333:
2330:
2329:
2327:
2323:
2317:
2314:
2312:
2309:
2307:
2304:
2300:
2297:
2295:
2292:
2291:
2290:
2287:
2285:
2282:
2280:
2276:
2273:
2272:
2270:
2268:
2264:
2254:
2251:
2249:
2246:
2244:
2241:
2240:
2238:
2236:
2232:
2226:
2223:
2221:
2218:
2216:
2213:
2212:
2209:
2206:
2204:
2200:
2197:
2195:
2194:Accommodation
2191:
2187:
2183:
2179:
2169:
2166:
2164:
2161:
2159:
2156:
2152:
2149:
2147:
2144:
2142:
2139:
2137:
2134:
2133:
2132:
2129:
2128:
2126:
2124:
2120:
2114:
2111:
2109:
2108:Optic atrophy
2106:
2102:
2099:
2098:
2097:
2094:
2090:
2087:
2086:
2085:
2082:
2081:
2078:
2075:
2073:
2069:
2065:
2061:
2057:
2052:
2048:
2034:
2031:
2029:
2026:
2024:
2021:
2019:
2016:
2014:
2011:
2009:
2008:Keratomycosis
2006:
2004:
2003:Globe rupture
2001:
1999:
1996:
1994:
1991:
1989:
1986:
1984:
1981:
1979:
1975:
1971:
1968:
1967:
1965:
1961:
1955:
1952:
1950:
1947:
1945:
1942:
1939:
1936:
1934:
1933:Macular edema
1931:
1929:
1926:
1924:
1921:
1919:
1916:
1914:
1911:
1907:
1904:
1902:
1899:
1897:
1894:
1892:
1889:
1887:
1884:
1882:
1879:
1877:
1874:
1872:
1869:
1868:
1867:
1864:
1862:
1859:
1857:
1854:
1852:
1848:
1845:
1843:
1842:Retinoschisis
1840:
1836:
1833:
1832:
1831:
1828:
1824:
1821:
1819:
1816:
1815:
1814:
1811:
1810:
1808:
1806:
1802:
1796:
1793:
1791:
1788:
1784:
1781:
1779:
1776:
1775:
1774:
1771:
1770:
1768:
1766:
1762:
1752:
1749:
1747:
1744:
1740:
1737:
1736:
1735:
1732:
1730:
1729:Choroideremia
1727:
1726:
1724:
1722:
1718:
1712:
1709:
1707:
1706:Iridodialysis
1704:
1702:
1699:
1697:
1694:
1692:
1689:
1687:
1684:
1682:
1679:
1678:
1676:
1671:
1668:
1666:
1663:
1662:
1659:
1656:
1654:
1650:
1640:
1637:
1635:
1634:Arcus senilis
1632:
1630:
1629:Haab's striae
1627:
1625:
1622:
1620:
1617:
1615:
1612:
1608:
1605:
1604:
1603:
1600:
1596:
1593:
1591:
1588:
1586:
1583:
1581:
1578:
1576:
1573:
1572:
1571:
1568:
1564:
1561:
1559:
1556:
1555:
1554:
1551:
1549:
1546:
1544:
1543:Corneal ulcer
1541:
1537:
1534:
1532:
1529:
1527:
1524:
1522:
1521:acanthamoebic
1519:
1517:
1514:
1513:
1512:
1509:
1508:
1506:
1504:
1500:
1494:
1491:
1489:
1486:
1485:
1483:
1481:
1477:
1474:
1472:
1471:Fibrous tunic
1468:
1464:
1460:
1455:
1451:
1437:
1434:
1432:
1429:
1427:
1424:
1422:
1419:
1415:
1412:
1411:
1410:
1407:
1405:
1402:
1401:
1399:
1397:
1393:
1387:
1384:
1382:
1379:
1377:
1374:
1372:
1369:
1367:
1364:
1363:
1361:
1359:
1355:
1349:
1348:Xerophthalmia
1346:
1344:
1341:
1339:
1336:
1334:
1331:
1330:
1328:
1326:
1322:
1312:
1309:
1307:
1304:
1302:
1299:
1297:
1294:
1293:
1291:
1289:
1285:
1279:
1276:
1274:
1271:
1269:
1266:
1264:
1261:
1259:
1256:
1254:
1253:Lagophthalmos
1251:
1249:
1246:
1244:
1241:
1240:
1237:
1231:
1228:
1226:
1223:
1221:
1218:
1216:
1213:
1212:
1210:
1206:
1203:
1201:
1197:
1193:
1189:
1184:
1180:
1173:
1170:
1169:
1163:
1158:
1156:
1151:
1149:
1144:
1143:
1140:
1127:
1123:
1122:
1118:
1117:
1114:
1110:
1103:
1099:
1098:
1094:
1092:
1088:
1087:
1083:
1081:
1077:
1076:
1072:
1068:
1066:
1062:
1061:
1057:
1053:
1052:
1049:
1044:
1040:
1026:
1020:
1016:
1011:
1007:
1003:
999:
994:
990:
986:
982:
981:
967:
963:
959:
955:
952:(3): 359–63.
951:
947:
940:
932:
928:
924:
920:
917:(5): 325–32.
916:
912:
905:
897:
893:
889:
885:
881:
877:
874:(4): 177–81.
873:
869:
862:
854:
850:
846:
842:
838:
834:
827:
819:
815:
810:
805:
801:
797:
793:
789:
785:
778:
763:
759:
753:
745:
737:
733:
726:
718:
714:
709:
704:
700:
696:
692:
688:
684:
677:
675:
666:
662:
658:
654:
647:
639:
635:
631:
627:
623:
619:
618:Ophthalmology
612:
604:
600:
595:
590:
587:(1): 116–27.
586:
582:
578:
571:
563:
562:eMedicine.com
559:
552:
544:
540:
533:
519:
515:
509:
505:
495:
492:
491:
485:
482:
478:
469:
465:
457:
453:
451:
447:
442:
440:
436:
432:
422:
419:
417:
406:
402:
400:
396:
391:
389:
384:
382:
377:
373:
371:
367:
351:
343:
341:
330:
328:
324:
314:
312:
308:
298:
296:
292:
291:corticospinal
288:
283:
273:
264:
262:
258:
254:
246:
242:
238:
234:
230:
226:
222:
218:
215:
212:, Brain stem
211:
207:
203:
199:
196:
192:
188:
184:
180:
176:
175:
174:
171:
169:
165:
155:
153:
148:
144:
140:
136:
134:
126:
121:
112:
109:
107:
103:
99:
95:
91:
87:
83:
79:
75:
74:cranial nerve
71:
67:
59:
56:
54:
50:
45:
41:
36:
32:
28:
23:
2486: /
2482: /
2461:Monochromacy
2393: /
2289:Heterophoria
2277: /
2252:
1976: /
1972: /
1876:hypertensive
1849: /
1670:Ciliary body
1585:Keratoglobus
1493:Episcleritis
1371:Enophthalmos
1366:Exophthalmos
1311:Trichomegaly
1306:Distichiasis
1208:Inflammation
1119:
1095:
1084:
1069:
1054:
1014:
1006:the original
1001:
988:
949:
945:
939:
914:
910:
904:
871:
867:
861:
839:(5): 283–6.
836:
832:
826:
791:
787:
777:
765:. Retrieved
761:
752:
743:
735:
731:
725:
693:(4): 415–8.
690:
686:
659:(5): 303–5.
656:
652:
646:
624:(1): 24–43.
621:
617:
611:
584:
580:
570:
561:
551:
542:
532:
521:. Retrieved
517:
508:
483:
479:
475:
466:
463:
454:
443:
428:
420:
412:
403:
392:
385:
378:
374:
362:
349:
336:
320:
317:Petrous apex
304:
279:
270:
250:
245:tuberculosis
214:Glioblastoma
183:hypertension
172:
161:
137:
130:
110:
69:
65:
64:
2611:Cycloplegia
2554:Photophobia
2549:Hemeralopia
2506:Hemianopsia
2484:Vision loss
2395:Aniseikonia
2386:Astigmatism
2306:Cyclotropia
2284:Hypertropia
2096:Papilledema
2068:Optic nerve
1901:Sickle cell
1881:Purtscher's
1866:Retinopathy
1734:Choroiditis
1575:Keratoconus
1396:Conjunctiva
1273:Xanthelasma
1225:Blepharitis
323:mastoiditis
285:result. In
247:meningitis.
229:sarcoidosis
143:suppression
30:Other names
2695:Categories
2660:Infections
2581:Anisocoria
2544:Asthenopia
2537:subjective
2521:homonymous
2516:bitemporal
2468:Nyctalopia
2456:Dichromacy
2400:Presbyopia
2361:Refraction
2182:Strabismus
2072:Optic disc
1431:Pinguecula
1296:Trichiasis
1097:DiseasesDB
868:Strabismus
523:2018-04-17
500:References
409:Management
257:idiopathic
253:neoplastic
233:vasculitis
221:metastasis
210:meningioma
195:idiopathic
106:synergists
2632:Nystagmus
2606:Mydriasis
2480:Blindness
2426:Amblyopia
2414:Blindness
2374:Hyperopia
2299:Exophoria
2294:Esophoria
2279:Exotropia
2275:Esotropia
1813:Retinitis
1511:Keratitis
1488:Scleritis
1421:Pterygium
1301:Madarosis
1248:Ectropion
1243:Entropion
1220:Chalazion
1121:eMedicine
435:amblyopia
354:Diagnosis
276:Brainstem
133:esotropia
125:abduction
98:esotropia
58:Neurology
53:Specialty
2671:Trachoma
2436:Diplopia
2131:Ischemic
2056:Pathways
1970:Glaucoma
1871:diabetic
1773:Cataract
1711:Synechia
1563:Meesmann
1531:Exposure
1516:herpetic
1414:allergic
1404:Chemosis
1338:Epiphora
966:11239870
931:14566314
896:26005299
888:17162438
818:29505103
717:12640051
603:21572867
488:See also
439:diplopia
416:diplopia
217:aneurysm
179:diabetes
139:Diplopia
102:diplopia
76:VI (the
2511:binasal
2498:Anopsia
2441:Scotoma
2235:palsies
1998:Red eye
1983:Floater
1790:Aphakia
1721:Choroid
1691:Hyphema
1681:Uveitis
1288:Eyelash
1126:oph/158
1091:D020434
853:7837013
809:6494416
767:9 April
708:1738389
665:2195974
638:7375084
594:3092316
472:Surgery
2601:Miosis
2379:Myopia
2158:Kjer's
1906:photic
1805:Retina
1558:Fuchs'
1526:fungal
1503:Cornea
1480:Sclera
1263:Ptosis
1200:Eyelid
1188:Adnexa
1080:378.54
1021:
964:
929:
894:
886:
851:
816:
806:
715:
705:
663:
636:
601:
591:
311:clivus
282:fibers
241:stroke
191:trauma
145:. The
86:abduct
2625:Other
2573:Pupil
1963:Other
1607:sicca
1459:Globe
1358:Orbit
1065:H49.2
892:S2CID
346:Orbit
164:brain
158:Cause
68:, or
1765:Lens
1665:Iris
1215:Stye
1102:2868
1086:MeSH
1075:9-CM
1019:ISBN
962:PMID
927:PMID
884:PMID
849:PMID
814:PMID
792:2018
769:2018
713:PMID
661:PMID
634:PMID
599:PMID
1071:ICD
1056:ICD
954:doi
950:131
919:doi
876:doi
841:doi
804:PMC
796:doi
703:PMC
695:doi
626:doi
589:PMC
397:or
386:2.
379:1.
368:or
223:),
189:),
96:or
90:eye
84:to
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