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Fourth Nerve Palsy
August 2003

Q. I am a 47-year-old woman recently diagnosed with fourth nerve palsy. My primary symptoms are double vision and eye pain. The physicians I've been seeing told me there is no treatment for this because my case is considered mild (surgery may over correct it). So I have to live with it or wait until it gets worse. Are there any other treatments that you are aware of?

A. The 12 cranial nerves control the muscles of the head and face, and the fourth cranial nerve controls the muscle that moves the eye downward. If the fourth cranial nerve is injured or malfunctioning, the affected eye will appear to be gazing upward compared to the unaffected eye. Patients with this condition will tend to turn the head to one side to attempt to get vision only from the healthier eye.

This can occur as a congenital condition or in adulthood. It is imperative that a diagnosis be made to see if the cause can be found and treated. This will likely require an exam by a neurologist and further testing. Common causes include trauma, or poor blood supply to the affected nerve. Once this is determined, if the condition does not correct itself, certain special corrective lenses may help the vision problem itself.



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