Dr.PADMA BHARATHI KANDASAMY

Dr. UMA RAMALINGAM

Abstract

A 43 year old male presented to OPD with history of distortion of images on right lateral gaze for 15 days. No history of trauma or fever. No known co-morbidities. On evaluation, his BCVA was 6/6, N6 in both eyes. Anterior segment examination and IOP were normal in both eyes. Extra-ocular movements in left eye- full and free in all directions. In right eye there was restriction in abduction alone, whereas all other movements were full and free, suggestive of isolated right eye abducens nerve palsy. Dilated fundus examination in both eyes was normal. Investigations such as ESR, CRP, lipid profile, blood glucose levels, blood pressure were normal. However, serum homocysteine level was elevated (20.73 micromoles/litre). CT brain showed chronic lacunar infarct in left caudate nucleus and right corona radiata. This is a rare case of non-traumatic isolated unilateral abducens nerve palsy in a middle aged male associated with hyperhomocysteinemia in the absence of other risk factors.