Pediatric Nerve Palsies/Ocular Nerves Disorders

The nerves that control the movement of a child’s eyes may be disrupted by many factors, including disease and injury. Diagnosing nerve palsies or ocular nerve disorders in children requires careful examination by an experienced pediatric ophthalmologist, who has specialized knowledge of eye pattern movement. Children’s National Health System ophthalmologists have the in-depth expertise to make a diagnosis. Adults also may have similar eye movement disorders and also can be evaluated at Children’s Eye Clinic.

What are nerve palsies or ocular nerves disorders?

The movement and alignment of the eyes is controlled by multiple nerves originating from the brain. Processes that interfere with the precise functioning of these delicate nerves can lead to misalignment of the eyes or abnormal eye movements. Patterns of eye movement disruption can be attributed to specific nerve problems and are often linked to underlying disease processes.

Problems such as disruption of the blood supply, tumors, viruses, and injury can lead to disruption of the function of the cranial nerves. In some cases, children are born with problems moving the eye or controlling movement of the eye in certain directions. This may be due to abnormal development or function of one or more of the nerves.

What are the symptoms of nerve palsies or ocular nerves disorders?

Signs include limitation of eye movement or a sudden change in the alignment or movement of the eyes. Associated with this may be unusual fatigue, loss of appetite, or a change in behavior. Some, but not all, children will complain of double vision or headache.

How are nerve palsies or ocular nerves disorders diagnosed?

Oftentimes, a diagnosis may be made on the basis of the clinical examination alone. Sometimes, imaging studies to look at the pathways in the brain are helpful.

Misalignment of the eyes can be caused by many conditions, not all of which are due to nerve or nervous system abnormalities. An experienced pediatric ophthalmologist needs to carefully examine the patient to identify ocular nerve disorders. Specialized knowledge of patterns of eye movement disruption can help make a diagnosis and may help other specialists, such as neurologists, oncologists, or geneticists form a more complete picture of a child’s medical condition.

The physician will observe the child and watch their eye movements, perhaps while they watch a video or television screen. Careful measurements will be taken.

A complete diagnosis may require several examinations. In some, but not all cases, radiological studies, blood work, or further evaluation by another specialist may be recommended.

What is included in treatment of nerve palsies or ocular nerve disorders?

The treatment of eye movement problems depends on the underlying cause. Often, surgery to reposition and realign the eye muscles is required; this is done on an outpatient basis. Some patients require eye patching or prism glasses. Careful follow-up to monitor your child’s vision is essential, even after the eyes have been realigned.

Meet the Team

All members of the Pediatric Ophthalmology Team are trained to detect, properly diagnose, and manage nerve palsies in children and adults.


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Call 202-476-3015

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Our specialized pediatric ophthalmologists are experts at recognizing and treating complex eye conditions in infants and children.