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Paralytic squint
Strabismus
Key Points
- •CN VI palsy is the most common ocular motor palsy (~40%); microvascular ischaemia (diabetes/HTN) is the leading cause in adults ≥50
- •Pupil-involving CN III palsy is a neurosurgical emergency - PComA aneurysm until proven otherwise; urgent CT/MR angiography mandatory
- •Secondary deviation > primary deviation is the hallmark of paralytic squint (Hering's law) and differentiates it from restrictive strabismus
- •Microvascular CN palsies recover spontaneously in ~90% within 3–6 months; inject botulinum toxin to antagonist early in CN VI palsy to prevent contracture
- •Aberrant regeneration (lid-gaze dyskinesis) occurs ONLY with compressive/traumatic CN III palsy - its presence in a 'microvascular' palsy demands urgent re-investigation
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17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations