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Diagnostic Evaluation of Traumatic Cranial Nerve Palsies

Correspondence: Requests for reprints should be addressed to: A. Frances Walonker, C.O., Doheny Eye Institute, University of Southern California School of Medicine, 1450 San Pablo St., Los Angeles, CA 90033.

Acquired neurogenic ocular palsies are most frequently caused by head trauma. The three cranial nerves responsible for eye movement are particularly vulnerable to the contra-coup effects that cause traction by shifts in the brainstem. When a patient presents with a third nerve palsy with some pupil involvement, unless there is an actual definitive etiology of trauma, immediate referral to neurology is essential. Mild trauma can cause decompensation of a congenital fourth nerve palsy. Sixth nerve palsies can recover with full lateral rectus function, but residual esotropia may occur, leaving a younger child susceptible to amblyopia.

Key words: cranial nerve palsies, head trauma, esotropia