Paralytic strabismus in children. Etiologic incidence and management of the third, fourth, and sixth nerve palsies.

The results of a retrospective study of the etiologic incidence of all cases of third fourth, and sixth nerve palsies in patients at Wills Eye Hospital and St Christopher's Hospital are reported. A total of 121 patients ranging in age from birth to sixteen were studied. Thirty-two cases of third nerve palsy, eighteen cases of fourth nerve palsy, and sixty-two cases of sixth nerve palsy were identified in this series. Nine additional cases illustrated combinations of multiple nerve involvement. With few exceptions, acquired third nerve palsy in children is an ominous sign whereas the congenital form is generally indicative of developmental anomaly or birth trauma. Acquired sixth nerve palsy in a child is always a matter of concern since it may represent the first sign of a brain-stem glioma. Active force studies may be carried out periodically to assess the speed of recovery and indicate when it is time to initiate a more aggressive role in the surgical management. The surgical results in children with paralytic strabismus that have been carefully evaluated offer a favorable prognosis.