POSTTRAUMATIC ABDUCENS NERVE PALSY IN A YOUNG CHILD AND ITS SUBSEQUENT SURGICAL TREATMENT (CLINICAL CASE)

Abstract

Purpose – to describe the clinical features of posttraumatic abducens nerve palsy in children and to evaluate the functional and cosmetic effectiveness of staged surgical intervention using the Hummelsheim- Wright technique.

In 2017, a 4-year-old patient presenting with left eye strabismus underwent standard ophthalmological examinations, including fundus examination, B-scan ultrasonography, and assessment of ocular motility in nine gaze positions. The angle of deviation and fixation center were determined. According to the father’s history, on June 29, 2017, heavy object fell onto the child’s head, after which the patient was referred to a neurosurgical clinic. Magnetic resonance imaging (MRI) confirmed the diagnosis of pneumocephalus.

In addition to pleoptic therapy, surgical treatment was performed in stages: at stage I, recession of the medial rectus muscles of both eyes was carried out; at stage II, resection of the lateral rectus muscle of the left eye was performed, along with partial transposition of the superior and inferior rectus muscle fibers to the lateral rectus muscle using the Hummelsheim–Wright technique. Postoperatively, the angle of strabismus was reduced to 0°, and partial restoration of abduction of the left eye was achieved. Pleoptic therapy ensured stabilization of visual function. The patient’s cosmetic appearance and functional ocular motility improved significantly.

Conclusion
Muscle transposition surgery using the Hummelsheim-Wright technique is a reliable and effective surgical approach in children with posttraumatic abducens nerve palsy, providing favorable functional and cosmetic outcomes. This method may be recommended as a treatment of choice in similar clinical cases in pediatric ophthalmic practice.