International consensuses and guidelines on clinical practices on abducens nerve palsy by the Asia-Pacific Strabismus and Pediatric Ophthalmology Society (APSPOS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO)

Abstract

Abducens nerve palsy is the most common ocular motor neuropathy, with a population-based annual incidence of approximately 4.7–11.3 per 100,000. It classically manifests as esotropia, horizontal diplopia, abduction deficit and compensatory head turn. Management follows a stepwise approach: immediate evaluation and treatment of underlying causes, followed by nonsurgical interventions, and surgical correction if misalignment persists beyond six months. However, various etiologies make it challenging to accurately diagnose and manage abducens nerve palsy in a cost-effective way. Controversies persist regarding the optimal timing of neuroimaging, the utility of botulinum toxin injection, and the selection of surgical procedures for partial versus complete palsy. To address these controversies and standardize the care, the Asia-Pacific Strabismus and Pediatric Ophthalmology Society (APSPOS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) convened an expert panel of 21 experts from 12 countries/territories to discuss and vote on key consensus statements covering the evaluation and diagnosis, non-surgical management, and surgical management of abducens nerve palsy. 17 consensus statements were discussed, with 16 (94.12%) statements achieved ≥ 75% agreement. These statements can provide a practical, etiology-based algorithm to guide diagnosis and management of abducens nerve palsy.