What is sixth nerve palsy?

Sixth nerve palsy is a disorder that affects eye movement. It’s caused by damage to the sixth cranial nerve. The primary function of the sixth cranial nerve is to send signals to your lateral rectus muscle.

This small muscle is located on the outer side in your eye. It is responsible for turning your eye away from your nose. When the lateral rectus muscle weakens, your eye crosses inward toward your nose.

How common is sixth nerve palsy?

Please discuss with your doctor for further information.


What are the symptoms of sixth nerve palsy?

The common symptoms of sixth nerve palsy are:

  • Double vision (particularly when looking to one side)
  • Headaches
  • Pain around the eye

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes sixth nerve palsy?

There are several causes of sixth nerve palsy. The condition can be congenital and affect a person from birth. This is sometimes due to injury of the sixth cranial nerve during labor or delivery. But sometimes the cause of congenital sixth nerve palsy is unknown.

Various circumstances and illnesses can also cause the disorder. This includes a head injury or skull fracture that damages the sixth cranial nerve. The disorder may also develop as the result of inflammation in the sixth cranial nerve.

Other conditions that can cause sixth cranial nerve damage or inflammation include:

  • Stroke
  • Infection
  • Lyme disease
  • Brain tumor
  • Meningitis
  • Diabetic neuropathy
  • Multiple sclerosis
  • Brain aneurysm

The most common cause of sixth nerve palsy in children is trauma, like from an accident involving a head injury. In adults, the most common cause is a stroke.

Risk factors

What increases my risk for sixth nerve palsy?

Anyone can develop sixth nerve palsy, and there’s no particular group of people at higher risk for this disorder.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is sixth nerve palsy diagnosed?

  • Neurologic examination
  • Ophthalmoscopy
  • Computed tomography or magnetic resonance imaging
  • Sometimes a spinal tap
  • Sometimes blood tests

Usually, doctors can easily identify a 6th cranial nerve palsy, based on results of an eye examination. However, the cause is less obvious.

An ophthalmoscope (see Figure: What Is an Ophthalmoscope?) is used to look into the eye and check for evidence of increased pressure within the skull and abnormalities in blood vessels. Computed tomography (CT) or, preferably, magnetic resonance imaging (MRI) of the brain is done to exclude tumors and other abnormalities that may be increasing pressure within the skull. If results of imaging are normal, a spinal tap (lumbar puncture) may be done to determine whether an infection or bleeding is present.

If symptoms suggest vasculitis, blood is withdrawn to check for evidence of inflammation, such as certain abnormal antibodies (antinuclear antibodies and rheumatoid factor) and an abnormal erythrocyte sedimentation rate (ESR—how quickly red blood cells settle to the bottom of a test tube containing blood). After all tests are done, the cause may remain unknown.

How is sixth nerve palsy treated?

In some cases, treatment is unnecessary and sixth nerve palsy improves in time, such as when the disorder is caused by a viral infection that has to run its course. Other times, the disorder only improves once the underlying cause has been treated.

Treatment depends on your diagnosis. Your doctor may prescribe antibiotics if your sixth nerve palsy is caused by a bacterial infection.

Prescription-strength corticosteroids can treat sixth nerve palsy caused by inflammation.

If you have a brain tumor, symptoms of sixth nerve palsy may not improve until you have surgery, chemotherapy, or other treatments to remove the tumor or kill cancer cells.

You may never recover from sixth nerve palsy caused by trauma. Your doctor may monitor your condition over a six-month period. If double vision or strabismus hasn’t improved or worsens, options include wearing an eye patch over the affected eye long-term to alleviate double vision. Your doctor may also recommend prism glasses to provide single binocular vision and align your eyes.

Some medical procedures are also effective. These include Botulinum toxin injections (Botox) where your doctor paralyzes the muscles on one side of your eye to correct poor alignment. Eye surgery is another option. If successful, surgery can stop an affected eye from pulling inward toward the nose.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage sixth nerve palsy?

Please discuss with your doctor for further information.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: January 3, 2018 | Last Modified: January 3, 2018

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