---
title: Sixth nerve palsy
description: "Sixth nerve palsy affects the lateral rectus muscle, limiting outward movement of the eye. It causes horizontal double vision, especially when looking toward the affected side. ## Causes and presentation Onset can be sudden or gradual. - Common causes include…"
url: "https://bluefinvision.com/knowledge-base/topics/conditions-diseases/sixth-nerve-palsy/"
updated: "2025-12-17"
category: "Conditions & Diseases"
---

# Sixth nerve palsy

Sixth nerve palsy affects the lateral rectus muscle, limiting outward movement of the eye. It causes horizontal double vision, especially when looking toward the affected side.

## Causes and presentation

Onset can be sudden or gradual.

- Common causes include microvascular ischaemia, trauma, raised intracranial pressure, and tumours
- Esotropia worse on gaze toward the palsied side and at distance
- Compensatory head turn toward the affected side to reduce diplopia
- In children, may present with strabismus and risk of amblyopia

## Management

Treatment addresses both cause and symptoms.

- Investigation for underlying systemic or neurological disease, especially in younger patients
- Observation for spontaneous recovery in microvascular palsies over 3-6 months
- Temporary prisms or occlusion to relieve diplopia
- Strabismus surgery or botulinum toxin if deviation becomes stable but persistent