The Abducens Nerve (CN VI)

Original Author: Anand Radhakrishnan
Last Updated: October 25, 2018
Revisions: 23
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The abducens nerve is the sixth paired cranial nerve. It has a purely somatic motor function – providing innervation to the lateral rectus muscle.

In this article, we shall look at the anatomy of the abducens nerve – its  anatomical course, motor functions and clinical relevance.

Fig 1 – Schematic of the anatomical course of the abducens nerve.

Anatomical Course

The abducens nerve arises from the abducens nucleus in the pons of the brainstem, and exits at the junction of the pons and the medulla.

It then enters the subarachnoid space and pierces the dura mater to travel in an area known as Dorello’s canal.

The abducens nerve then enters the cavernous sinus at the tip of the petrous temporal bone. It leaves the cavernous sinus and enters the bony orbit via the superior orbital fissure. Within the bony orbit, the nerve terminates by innervating the lateral rectus muscle.

Fig 2 – Coronal section demonstrating the contents of the right cavernous sinus.

Motor Function

The abducens nerve innervates a single muscle – the lateral rectus, one of the muscles of oculomotion. This muscle takes its origin from the common tendinous ring, and acts to abduct the eyeball (i.e. to rotate the gaze away from the midline).

Fig 1.1 - Lateral view of the extraocular muscles.

Fig 3 – Lateral view of the extraocular muscles.

Clinical Relevance

Examination of the Abducens Nerve

The abducens nerve is examined in conjunction with the oculomotor and trochlear nerves by testing the movements of the eye. The patient is asked to follow a point (commonly the tip of a pen) with their eyes without moving their head. The target is moved in an ‘H-shape’ and the patient is asked to report any blurring of vision or diplopia (double vision).

Palsy of the Abducens Nerve

Any pathology which leads to downward pressure on the brainstem (e.g. brain tumour, extradural haematoma) can lead to the nerve becoming stretched along the clivus of the skull. Wernicke-Korsakoff syndrome (caused by thiamine deficiency and generally seen in alcoholics) is a rare cause of sixth nerve palsy.

Other causes of abducens nerve damage include diabetic neuropathy and thrombophlebitis of the cavernous sinus – in these cases, it is rare for the abducens nerve to be affected in isolation.

Patients will present with diplopia and a medially rotated eye which cannot be abducted past the midline. The patient may attempt to compensate by rotating their head to allow the eye to look sideways.

Fig 1.2 - Abducens nerve palsy. The right eye cannot be abducted past the midline.

Fig 4 – Abducens nerve palsy. The right eye cannot be abducted past the midline.

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Question 1 / 3
Which muscle does the abducens nerve innervate?
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Question 2 / 3
What action does the lateral rectus muscle have on the eyeball?
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Question 3 / 3
What is the characteristic feature of abducens nerve palsy?
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