Sixth nerve which innervates ipsilateral lateral rectus muscle is common to get paralysed in children. It has the longest course of travel from dorsal pons to lateral rectus muscle and may present as “False localising sign” due to its injury or compression anywhere along its pathway. The commonest cause has been found to be Tumour in Children unlike vascular aetiology in adults CN6 palsy in patients with tumour can possibly be a part of the tumour presentation tumour resection or tumour progression as mentioned by Dotan et. al. The second common cause is trauma Other causes being elevated Intra-cranial pressure (ICP), congenital, inflammation, idiopathic, post-viral.

Except for neoplasm, other causes of acquired Abducens palsy mostly presents with esotropia only. Slowing of saccadic velocities of ipsilateral lateral rectus is one important feature which differentiates esotropia due to sixth nerve palsy from other types. Trauma causes shearing forces on the nerve as it crosses the petrous part of temporal bone. patients are labelled to have Benign Abducens nerve palsies when no definite aetiology of paresis is found and mostly follow a viral episode or post-vaccination.