A Case of Lateral Rectus Palsy

Dr Sunil Kannada, BHMS

Chief Medical Officer (H), In charge DGHD Hindustani Dawakhana, Ballimaran, Directorate
of AYUSH, Govt. of NCT of Delhi. Email:drsunilkannada@rediffmail.com

Abstract
A 10 years old child was seen with bilateral lateral rectus palsy, more marked on
the left side. The parents of the child dated the squint to an episode of emotional
distress about two months earlier. A single dose of homoeopathic remedy,
Staphysagria 1M, showed reduction in squinting in the child within a month.
Second dose of the same remedy, repeated three months later, removed the squint
completely in a span of seven months. Homoeopathic treatment can therefore be
useful in ophthalmological and neurological conditions.

Keywords
Lateral rectus palsy; Homoeopathy; Staphysagria

Introduction
Lateral rectus palsy (LR palsy) occurs due to weakness of abducens nerve (6
th

cranial nerve) which presents as a kind of squint, in which the affected eye is
turned inwards (towards the nose).The patients presenting with LR palsy are not
able to maintain alignment of eyes in all directions of gaze (incomitant variety of
squint) and hence may experience diplopia(1). The children may not complain of
diplopia but if left untreated may develop amblyopia.

Since the nerve has a long course from brain stem to the lateral rectus muscle of
eye, numerous other neurological structures may be involved, and the patient may
have other associated complaints viz. hearing loss, droopy eyelid (ptosis), facial
weakness etc.

Aetiology
The most common causes of LR palsy in adults and children are:
Adults:
1. Vasculopathic: Hypertension, Diabetes Mellitus, Atherosclerosis etc.
2. Trauma
3. Idiopathic
Children:
1.Trauma
2. Neoplastic
3. Idiopathic
Viral infections, Increased intracranial pressure, Giant cell arteritis, Cavernous
sinus mass, Multiple sclerosis, Vasculitis, Sarcoidosis, Post lumbar puncture or
myelography etc. are the less common causes.

Recovery and case management
It is possible for cases of LR palsy to spontaneously improve over a period of time
depending upon the cause viz. viral infections can recover completely whereas post
traumatic may have residual effects depending on severity of trauma. However, it
is generally expected that maximum improvement takes place during the first 6
months of onset of complaints. Improvement may also take place with use of
Fresnel Prisms or by occluding vision of the affected eye. Medicinally, Botulinum
toxin injection is given to the ipsilateral Medial rectus to weaken it or steroids in
other conditions. Surgically Hummelsheims transposition or Jensens (2,3,4)

method may be required.

Homoeopathic perspective
The eye has been called "the mirror of the mind". This expression has more
meaning to it than what the poet or the romantics may have meant. This
particularly so for the Homoeopath, who by his philosophy takes an overall view of
all diseases. As such, the condition or ailment of some part of the body that is
nearer the surface and visibly and palpably deranged, is not taken as a local
disease but as a general disease expressing itself at that place at a particular
period of time. Therefore, to the Homoeopath, the eye is not an organ requiring
"local" therapeutics. It pertains to one whole: the organism, being irrigated by the
same blood, bathed by the same lymph and innervated by the same nervous
current.(5)

The selection of the homoeopathic remedy shall therefore depend upon the
individual history, features of mind and disposition, objective signs, aetiological
factors, concomitant symptoms, characteristic modalities etc.

S.R Wadia, in his book on Homoeopathy in Childrens Diseases, has given a case of
post traumatic bilateral LR palsy with squint that was cured with Causticum.(6)

Apis, Belladonna, Cicuta, Cina, Cyclamen, Causticum, Gelsemium, Jaborandi ,
Natrum mur , Natrum salicylicum, Santonine, Stramonium, Zincum met are some
of the homoeopathic medicines that are recommended for LR palsy in
homoeopathic materia medica.(7,8)

Case report
Master F, 10 years old, was brought for consultation for squinting in both the eyes,
which was more marked in the left eye. While looking straight, left eye was seen
getting deviated towards nose. The child complained of having double vision,
which reducedby tilting the head to one side. Complaint was first noted by the
parents about two months back, soon after the child was rebuked harshly by his
father for watching his favorite cartoon show and holding the remote with him so
that nobody could change the channel. After father snatched the remote control
from the child, he became very angry and started crying. Squinting was first seen
within a few days of this episode. Parents waited for few days for the complaint to
get resolved spontaneously but as that did not happen they took him to an
ophthalmologist who diagnosed him with bilateral LR palsy. The parents also
reported that his squint was much more visible whenever the child was angry.

Past illness
Chicken Pox at the age of 4 years.

Family history
Hypertension (paternal and maternal side); Diabetes mellitus (maternal side)

Physical generals
Desire: Sweets, aerated drinks
Thermal reaction: Chilly patient.

Mental generals
Highly sensitive; irritable.

Prescription & follow up




Date Observation Prescription
07.06.2013 Squinting of both eyes, more
with Left eye. Tilting of head to
one side while looking.
Staphysagria
1M/1Dose
PL for 3 weeks
26.06.2013 Seems a bit improved Placebo
20.07.2013 Visible improvement in the
condition
Placebo
01.08.2013 Marked improvement noted Placebo
04.09.2013 Improvement seems status quo Staphysagria
1M/1dose
05.11.2013 Generally better.(An MRI
conducted showed no
detectable pathology)
Placebo
02.01.2014 No squinting is noted. No head
tilt.
Placebo.



Picture
(At the time of first consultation) Dated
07.06.2013
Picture
Dated 02.01.2014

Discussion & conclusion
Canadian Journal of ophthalmology had published two case studies where
emotional factors have acted as aggravating/ triggering factor in cases of
strabismus.(9,10)

In this case too, we found such an aetiological/ triggering factor. The squint
developed in the child right after the episode at home. Further, parents repeatedly
stressed that squinting was worse whenever the child would be angry. Taking this
as a characteristic feature of the case, the rubrics Anger, ailments after, with
indignation & Anger, suppressed from were referred to, for the case, in Kents
Repertory.(11)

The other characteristic features of the case were:
1. Highly sensitive and irritable patient. (12,13,14)
2. Chilly patient.(15,16)
3. Strong desire for stimulating drinks. (17)

The remedy was found mentioned prominently in the rubrics and also covered the
other characteristic features. However, Staphysagria was not mentioned under the
rubric Strabismus in Kents Repertory. Since the remedy covered the generalities
of the patient besides the triggering/ modifying factor it was prescribed to the child.
Also the emotional causation and effect in eye warranted the prescription of high
potency, hence 1M potency was selected.

The improvement in the case highlights the efficacy of homoeopathy in both
ophthalmological and neurological diseases. It shall be wise to remember the
words of late Dr Pierre Schimdt, who said, Local diseases do not exist, but solely
localised, morbid affections are to be found.

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