Abstract Details

Title Effectiveness of Prism Therapy Versus Botulinum Toxin Injection in the Management of Sixth Cranial Nerve Palsy: A Systematic Review and Meta-analysis

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 17-012

Objective To compare the effectiveness of prism therapy versus botulinum toxin injections in improving ocular alignment and reducing diplopia in sixth cranial nerve palsy.

Background

Sixth cranial nerve palsy causes horizontal double vision due to impaired lateral eye movement. Prism therapy and botulinum toxin injections are common treatments, but their comparative effectiveness remains unclear.

Design/Methods A literature search of PubMed, Embase, Scopus, and Cochrane databases was performed from their inception until September 31, 2025. Pooled estimates were calculated using random-effects models, reporting risk ratio RR with 95% confidence intervals (CI). Heterogeneity was evaluated using I² and X² statistics. All statistical analysis were performed in R Studio (v4.4.3) using "meta" package. A p-value of <0.05 was considered statistically significant.

Results This meta-analysis included four studies with 194 patients (Prism therapy=102; Botulinum toxin injection=107) with sixth cranial nerve palsy. Prism therapy was not significantly different from botulinum toxin injection in improving overall success rates in sixth nerve palsy (RR 0.89, 95% CI 0.68–1.15, p = 0.375, I² = 27.5%). No significant differences were observed in the angle of deviation among recovered patients (RR 1.23, 95% CI 0.70–2.17, p = 0.468, I² = 0%) or non-recovered patients (RR 1.11, 95% CI 0.53–2.34, p = 0.785, I² = 0%). Severity of the palsy showed that in grade –4 abduction deficit, botulinum toxin was associated with a higher recovery rate (RR 0.60, 95% CI 0.32–1.16, p = 0.128, I² = 10.4%) though the difference was not statistically significant, whereas in grade –5 palsy, no significant difference was found between interventions (RR 0.87, 95% CI 0.51–1.49, p = 0.613, I² = 46.4%).

Conclusions Botulinum toxin and prism therapy show similar effectiveness in sixth nerve palsy. Botulinum toxin may offer better recovery in moderate cases, but no clear advantage is seen in severe palsy. Further studies are needed to confirm these findings.

Authors/Disclosures
Areej Riaz, MBBS PRESENTER	Dr. Riaz has nothing to disclose.
Erum Habib, Optometrist	Miss Habib has nothing to disclose.
Omar Abdullah Gill, MBBS	Mr. Gill has nothing to disclose.
Maria Qadri, MBBS	Dr. Qadri has nothing to disclose.
Ariba Asif, MBBS	Dr. Asif has nothing to disclose.
Sana Iftikhar (Sheikh khalifa bin zayad Al Nahyan Medical and dental college Lahore)	Ms. Iftikhar has nothing to disclose.
Sahla Waqas, MBBS	Ms. Waqas has nothing to disclose.
Muhammad Usman Iqbal, MBBS	Mr. Iqbal has nothing to disclose.
Syeda Vilay Z. Rizvi, MBBS	Miss Rizvi has nothing to disclose.
Muhammad Moiz Javed, MD	Dr. Javed has nothing to disclose.

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