Alghofaili Ruba Saleh
Department of Ophthalmology, College of Medicine, Qassim University, Qassim, Saudi Arabia.
Case Rep Ophthalmol. 2025 May 9;16(1):426-429. doi: 10.1159/000546210. eCollection 2025 Jan-Dec.
Transient sixth cranial (abducens) nerve palsy is uncommon, especially in children, in whom it can herald serious underlying pathology. Sixth nerve palsy has been reported after spinal anesthesia and lumbar puncture and, in very rare cases, after complicated general anesthesia or ocular muscle procedures. Acute strabismus in children is always a concerning occurrence for both parents and clinicians, so an accurate record of documented etiologies is essential to guide appropriate management and to reassure the parents.
Here we report the first case of transient unilateral sixth nerve palsy following general anesthesia for a non-ocular surgical procedure (adenoidectomy) in a 5-year-old child. Ocular motility assessment confirmed right-sided abducens nerve palsy and MRI excluded underlying pathology. The right eye movement gradually improved over the following 2 weeks and the child made a full recovery.
Given the favorable prognosis, watchful waiting is an appropriate management strategy provided that the more common sinister causes of sixth nerve palsy have been carefully excluded.
暂时性第六颅神经（展神经）麻痹并不常见，尤其是在儿童中，它可能预示着严重的潜在病变。脊髓麻醉和腰椎穿刺后曾有展神经麻痹的报道，在极少数情况下，复杂的全身麻醉或眼肌手术后也会出现。儿童急性斜视对家长和临床医生来说始终是令人担忧的情况，因此准确记录已证实的病因对于指导适当的治疗以及安抚家长至关重要。
在此，我们报告首例5岁儿童在非眼科手术（腺样体切除术）全身麻醉后出现暂时性单侧展神经麻痹的病例。眼动评估证实为右侧展神经麻痹，磁共振成像排除了潜在病变。右眼运动在接下来的2周内逐渐改善，患儿完全康复。
鉴于预后良好，在仔细排除展神经麻痹更常见的严重病因后，密切观察等待是一种合适的治疗策略。
