ArticleGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie2026
Do steroids improve outcomes of idiopathic sixth nerve palsy in children?
Article in Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo analyze the effect of systemic steroid treatment in children with benign acquired isolated sixth nerve palsy (BAISNP) regarding healing, recurrence risk and late sequelae.
methodsA retrospective cohort design was used. The clinical database of a single medical center was reviewed for all children with BAISNP between 2016 and 2024. Data were collected as follows: demographics, age at initial presentation, complete eye and neurological examinations at presentation and every follow-up visit, neuroimaging and LP findings, treatments at presentation or for residual ocular misalignment, recovery periods and recurrences. Systemic steroids (1 mg/kg/day oral prednisolone for 10 days) were recommended by certain physicians, to whom some patients were randomly assigned.
resultsTwenty-seven children were included in the study. Mean age at presentation was 2.6 ± 2.2 years with a follow-up of 2.0 ± 2.3 years. BAISNP completely resolved after 3.2 ± 3.1 months in all children. Nine children (33%) had a recurrence that resolved after 1.8 ± 0.7 months. Residual comitant esotropia (RCE) exceeding 10 prism diopters persisted in six children (22%) despite resolution of the abduction weakness. Three of them underwent surgery and none regained stereopsis. Fifteen children (56%) received systemic steroids upon presentation. Steroid treatment affected neither time to resolution nor recurrence rate. However, fewer children treated with steroids developed RCE (6% vs. 45%, p = 0.026). A multivariable analysis for RCE development found that only steroids had a statistically significant impact (β=-0.58, p = 0.006).
conclusionsSystemic steroids reduce the rates of RCE when administered during an acute episode of BAISNP.
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