Pediatric Cranial Nerve Palsies

Some causes of cranial nerve palsies affecting the eyes include:

• Congenital (present at birth) development problems
• Diseases including diabetes, stroke, and high blood pressure
• Traumatic brain injury (TBI)
• Infections
• Pressure inside the brain from tumors or aneurysms 

Symptoms of cranial nerve palsies can differ depending on the particular nerve that is affected. You or your child’s pediatrician may see symptoms like the following:

• Either eye may look inward, outward, upward or downward
• Drooping eyelid (ptosis)
• Double vision (described by older children)
• Enlarged pupil
• Lazy eye: Inability of one eye to align or focus
• Head tilt to compensate for the eye misalignment
• Reduced or abnormal eye movement 

You or your child’s pediatrician may notice problems with your child’s eye alignment or movement. A routine eye exam and a more thorough exam by a pediatric ophthalmologist will help pinpoint the condition. 

At Children’s National, we may recommend further testing to find out what is causing the cranial nerve palsies, as follows:

• Diagnostic imaging, including CT and MRI scans of the brain and orbits
• Blood pressure and blood tests to check for diabetes, high blood pressure or thyroid disease 

Cranial nerve palsies often resolve themselves over a few months. If they do not, our focus is to treat the symptoms as well as the underlying cause. At Children’s National, our treatment options include:

• Glasses to improve vision and eliminate double vision
• Surgery on the eye muscles to realign the eyes and eliminate double vision and ptosis
• Surgery to remove tumors, aneurysms or other problems creating pressure on the cranial nerves
• Treatment of underlying diabetes, high blood pressure or thyroid disease