Abstract:
Background
Isolated lateral rectus (LR) palsy is a common cranial nerve palsy with a variety of causes. Horizontal
diplopia is frequently caused by isolated LR palsy, a common cranial nerve palsy in adults. The abducens
nerve is vulnerable to a variety of vascular, inflammatory, traumatic, viral, and compressive diseases
because of its lengthy intracranial journey. This study aims to describe the clinical profile, etiological
distribution, and outcomes in adults with isolated LR palsy.
Methodology
This retrospective observational study included 29 consecutive adults diagnosed with isolated LR palsy.
Demographic characteristics, clinical presentation, investigation findings, etiological diagnoses, and
recovery outcomes during follow-up were systematically recorded and analyzed using descriptive statistical
methods.
Results
The mean age was 48.17 years (range = 19-85 years), with a male-to-female ratio of 15:14. Etiologies
included diabetes-related microvascular ischemia in seven (24.1%) patients, hypertension-related
microvascular ischemia in seven (24.1%) patients, infection with inflammation in four (13.8%) patients,
trauma in four (13.8%) patients, idiopathic causes in two (6.9%) patients, tumor in one (3.4%) patient,
cavernous sinus thrombosis in three (10.3%) patients, and microvascular ischemia associated with both
diabetes mellitus and hypertension in one (3.4%) patient. At the last follow-up, 19 (65.5%) patients had
complete recovery, two (6.8%) had partial recovery, one (3.4%) had no recovery, and seven (24.1%) were lost
to follow-up.
Conclusions
Microvascular ischemia associated with diabetes mellitus and hypertension was the leading cause of isolated
LR palsy in adults. Most patients demonstrated improvement during follow-up, whereas traumatic and
compressive etiologies showed relatively poorer outcomes. Careful systemic evaluation and targeted
neuroimaging are important in patients with atypical presentations or suspected non-microvascular causes.
These findings emphasize the importance of systematic clinical assessment, etiological evaluation, and
follow-up in adults presenting with isolated LR palsy.
