Pediatric Nerve Palsies/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.

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.

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.

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.

• Merck Manuals Online Medical Library
• Trochlear Nerve Palsy