Abstract
Acquired neurogenic ocular palsies are most frequently caused by head trauma. The three cranial nerves responsible for eye movement are particularly vulnerable to the contra-coup effects that cause traction by shifts in the brainstem. When a patient presents with a third nerve palsy with some pupil involvement, unless there is an actual definitive etiology of trauma, immediate referral to neurology is essential. Mild trauma can cause decompensation of a congenital fourth nerve palsy. Sixth nerve palsies can recover with full lateral rectus function, but residual esotropia may occur, leaving a younger child susceptible to amblyopia.