Clinical profile of patients with isolated lateral rectus palsy in adults

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.