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  • Neuro-Ophthalmology/Orbit

    Review of: Risk of abducens nerve palsy following COVID-19 vaccination

    Chauhan M, Eleiwa T, Abdelnaem S, et al. Journal of the American Association for Pediatric Ophthalmology and Strabismus, April 2024

    While there have been reports of abducens nerve palsy after COVID-19 vaccination, it is not clear if there is a direct link between the 2 events.

    Study Design

    In this retrospective, multinational, population-based study, COVID-19 Research Network data from 110 million patients were used to compare the prevalence of newly diagnosed abducens nerve palsy or diplopia within 21 days of receiving the first and second doses of the COVID-19 vaccine. The prevalence of newly diagnosed abducens palsy was also compared with that seen after receiving the influenza or Tdap vaccines. To ensure accurate results, the study used propensity score matching to control for demographic and medical factors.


    The researchers identified 3,545,224 patients (mean age 46.2 ± 21.3 years) who had received their first dose of the COVID-19 vaccine and subsequently developed abducens nerve palsy or diplopia within 21 days. The risk of a first-time diagnosis of abducens nerve palsy or diplopia after COVID-19 vaccination was found to be 0.002% and 0.036%, respectively. The risk of developing new-onset abducens palsy following COVID-19 vaccination was similar to that seen following influenza or Tdap vaccination; there was also no difference in risk after the first and second COVID-19 vaccine doses. The risk of developing new-onset diplopia after COVID-19 vaccination was lower than the risk after influenza or Tdap vaccination; however, there was a greater risk of diplopia after the first COVID-19 vaccine dose than after the second dose.


    It is important to note that the data were extracted from a large database using diagnosis codes that lack detailed information. Furthermore, the study only looked at the data for the 21-day period following the vaccination. The study also excluded patients who already had a prior abducens nerve palsy diagnosis.

    Clinical Significance

    Based on these findings, there does not appear to be a causal relationship between COVID-19 vaccination and development of abducens nerve palsy. This information can help to alleviate vaccine hesitancy and promote public safety awareness.

    Financial Disclosures: Dr. Tammy Yanovitch discloses no financial relationships.